[Does computer-aided navigation of endonasal sinus surgery improve process quality and outcome quality?].
BACKGROUND
Ever since navigation technology was introduced into endonasal surgery, its impact on process and result of surgery has been debated. In this respect, factors of investment costs and additional costs for time exposure will be discussed as well.


METHODS
In a retrospective analysis of quality assurance, the results of endonasal surgery by surgeons of different experience in 56 patients were evaluated. Preparation time, preoperative setup time as well as time of actual surgery were analysed and compared with possible indications for navigation.


RESULTS
From our analysis a classification resulted dividing the indications for navigation into the following four different categories: redundant, reasonable, helpful, necessary. Navigation was redundant when it was dispensable and did not result in a clear improvement of process or outcome quality. Navigation has been proved reasonable when it helped to obtain additional information for improving process quality. It was considered helpful when the information obtained by navigation had an influence at least on the course and/or result of surgery. Navigation was necessary from the surgeon's point of view when the intervention in regard to the benefit-risk-ratio could not be justified without navigation, or only intraoperative slice imaging would allow surgery.


CONCLUSIONS
Not only redundant, but also facultative and obligatory indications for navigation in endonasal surgery result from careful consideration of the risk-benefit-cost ratio. In standardized endonasal sinus surgery, like infundibulotomy or ethmoidectomy, however, navigation can be a hindrance to process quality and does not result in any advantage for outcome quality.
Schipper
J
J
Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg. schipper@hno.ukl.uni-freiburg.de
Ridder
G J
GJ
Aschendorff
A
A
Klenzner
T
T
Arapakis
I
I
Maier
W
W
D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D019723:Endoscopes; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011127:Polyps / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012086:Reoperation / Q000295:instrumentation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012852:Sinusitis / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013673:Technology Assessment, Biomedical / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data