COMPARATIVE EFFICACY OF MANUAL VS POWERED INSTRUMENTATION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)

Abstract

Functional endoscopic sinus surgery (FESS) is the gold‐standard intervention for chronic rhinosinusitis refractory to medical therapy, yet optimal choice of instrumentation remains unsettled. In this prospective, randomized study of 100 adult patients, we directly compared manual instrumentation using forceps and dissectors versus powered microdebrider‐assisted FESS under standardized operative conditions. Primary quantitative outcomes demonstrated that powered instrumentation significantly reduced mean operative time (58.7 ± 12.3 min vs. 82.3 ± 15.4 min) and intraoperative blood loss (118.9 ± 40.7 mL vs. 205.6 ± 50.2 mL), while achieving higher mucosal preservation scores on a 1–5 scale (4.5 ± 0.5 vs. 3.2 ± 0.8; all p < 0.01). Early postoperative recovery favored the powered group, with lower mean SNOT-22 scores at Weeks 1 (28.4 ± 7.9 vs. 30.2 ± 8.4), 4 (22.3 ± 6.8 vs. 25.1 ± 7.2), and 12 (18.1 ± 5.9 vs. 20.3 ± 6.5), and improved endoscopic healing per Lund–Kennedy scores at Week 12 (4.1 ± 0.9 vs. 3.8 ± 1.0; p < 0.05). Complication rates were lower in the powered cohort, with reduced incidences of synechiae (16 % vs. 20 %), bleeding (6 % vs. 10 %), and infection (2 % vs. 4 %), yielding a higher proportion of uncomplicated recoveries (76 % vs. 66 %). Semi‐structured interviews with ten rhinologic surgeons revealed that powered instrumentation enhanced visualization, ease of access in complex anatomies, and ergonomics (cited in 9–10 interviews), although manual tools retained perceived advantages in tactile feedback. These findings indicate that powered FESS not only streamlines surgical efficiency and minimizes intraoperative trauma but also promotes more rapid early symptom resolution and mucosal healing. Given the trade‐offs in tactile control and equipment costs, selection of instrumentation should be individualized based on case complexity, surgeon expertise, and resource availability. Further multi‐center trials with long‐term follow‐up and cost‐effectiveness analyses are recommended to establish definitive guidelines for instrumentation choice in FESS.