title: Safety in endoscopic sinus surgery.
abstract: OBJECTIVE
  Endoscopic sinus surgery techniques and technologies have undergone rapid development over the past two decades. Recently, image guided systems have been implemented in endoscopic sinus surgery, carrying the promise of increased safety during surgery. This review compiles available data regarding the incidence of complications in endoscopic sinus surgery, the trends over time, and the impact of image guided surgery on complication rates.
  
  
  RESULTS
  Reporting of complications in endoscopic sinus surgery is widely variable, confounding attempts to establish accurate data regarding complication rates. Few prospective, randomized trials exist comparing the safety of functional endoscopic sinus surgery with other surgical techniques. Major complications occur in 0-1.5% of cases and minor complications occur in 1.1-20.8% of functional endoscopic sinus surgery cases. Powered instrumentation does not appear to affect the incidence of complications, but may increase the severity of complications. It is unclear whether image guided surgery results in lower complication rates. Practical and ethical considerations make randomized trials to evaluate this issue problematic.
  
  
  CONCLUSIONS
  In order to maximize safety, functional endoscopic sinus surgery surgeons must individually and collectively audit current practice, report complications in a systematic way, utilize available technology appropriately to support safe surgery, and diligently refine surgical technique as well as the systems supporting endoscopic surgical practice.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. mcmains@uthscsa.edu
authors.forename: K Christopher
authors.initials: KC
authors.lastname: McMains
mesh_terms: D004724:Endoscopy / Q000009:adverse effects; D006801:Humans; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D011183:Postoperative Complications; D012449:Safety