Table 3. Qualitative synthesis of the included studies.
Study Population n Outcomes Results Conclusion
Javer 2006
CRS
IGS: 80 ESS: 15
RSOM-31
A significant improvement in quality of life was observed, following IGS compared with ESS, in the subgroups nasal symptoms, ear symptoms, general symptoms and practical problems.
The improvement in overall quality of life six months post-ESS appeared to be further enhanced when computer assistance was added to endoscopic sinus surgery.
Jiang 2014
CRS (revision surgery)
IGS: 51 ESS: 30
Sphenoid sinus penetration
IGS: 83 out of 91 sphenoid sinuses were successfully opened. ESS: 35 out of 51 sphenoid sinuses were successfully opened.
IGS was a beneficial procedure for opening the sphenoid sinus, especially in the revision cases.
Lorenz 2006
CRS
IGS: 35 ESS: 35 Navigation Accuracy, Set up time Gain in security for the surgeon, Complications IGS: two patients had complications. ESS: six patients had complications. Gain in safety (1-5) with IGS: average 4.4 (±0.25) Additional effort with IGS (1-3): Average 1.8 (±0.75).
The question, whether using IGS a higher security can be reached with a lower complication rate cannot be answered so far. It is remarkable the subjective assessment of the surgeon who claim to have experienced a security gain with IGS.
Singh 2020
CRS
IGS: 30 ESS: 30 Operating room time
System accuracy
Blood loss Complication
IGS: No complications. Blood loss: 566.67 (± 62.23) Operating room time: 165.68 (± 6.55) ESS: One complication (orbital swelling) Blood loss: 636.33 (± 72.59) Operating room time: 163.33 (± 5.43) Accuracy within 2 mm.
IGS improves the confidence of surgeons in reaching difficult areas safely leading to thorough disease clearance, especially in revision cases, altered anatomy, or extensive disease cases. The additional time taken for device setup and registration was effectively overcome by the reduced intraoperative time. Blood loss and complications did not differ significantly with or without IGS.
Stelter 2011
CRS
IGS: 80 ESS: 77
Postoperative drained paranasal sinuses
IGS: two missed paranasal sinuses / three complications ESS: five missed paranasal sinuses/ three complications.
IGS should have an assured place in training and teaching for paranasal sinus operations. Even if this new technology means extra costs, it was welcomed by all study participants (surgeons and patients).
Strauss 2009
CRS
IGS: 150 ESS: 150 Operating room time Successful sphenoidal sinusotomy Patient subjective assessment Incision-suture time: average 10.1 min less with IGS. Perioperative preparation time: 7 min on average more with IGS. Successful sinusotomy: IGS: 31/31 ESS: 9/40. Patient assessment: general feeling of well-being 73% IGS / 69% ESS; Minimal improvement, no improvement or worsening 16% IGS /30% ESS; would have the surgery again: 96% IGS/85% ESS.
The advantages of the examined navigation system compared to the gold standard of ESS are proven. Navigation assistance led to reduced intraoperative time, increased postoperative results, and lowered the workload of the surgeons.