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Trends in computer-assisted navigation during endoscopic sinus surgery among US adults, 2018–2026

by | Sep 23, 2026

trends in computer assisted sinus surgery from daily updated EHR data
  • Use of computer-assisted navigation in endoscopic sinus surgeries increased from 29.2% in 2018 to 41.0% in 2026.
  • Rate of computer-assisted navigation varied by demographic and clinical factors.

Endoscopic sinus surgery is a minimally invasive procedure that uses a small camera inserted through the nose to access and open blocked sinus passages, allowing the sinuses to drain and function properly (1, 2). It is commonly used to treat sinonasal disorders, such as chronic rhinosinusitis, recurrent acute sinusitis, nasal polyps, mucoceles, cysts, and structural abnormalities that interfere with airflow or mucus drainage (1). For patients who do not respond to treatments such as medications or saline rinses, this procedure can lead to significant symptom relief, reduce infections, and improve overall quality of life (1, 3).

Computer-assisted surgical navigation is often used to support endoscopic sinus surgery when the usual sinus structures are altered or difficult to identify, when the disease is extensive, or when the surgery is close to important areas like the eyes or skull base. This technology integrates preoperative CT imaging with real-time tracking of surgical instruments, essentially functioning like a GPS system to help guide the surgeon with greater precision and safety (4).

Studies evaluating computer-assisted navigation systems for endoscopic sinus surgery have generally shown high accuracy in identifying anatomic structures, although this reflects a broad range of technologies that have evolved over time (5–8). Research assessing their use in endoscopic sinus surgery has demonstrated mixed results, with some studies suggesting benefits, but others finding no meaningful differences in outcomes (7, 9–13). Major professional societies endorse the use of computer-assisted navigation in complex cases (14, 15). Surgeons performing endoscopic sinus surgery consistently report high satisfaction with computer-assisted navigation technologies, noting reductions in surgical stress (16, 17).

We examined trends in the use of computer-assisted navigation among adult patients undergoing endoscopic sinus surgery in Truveta Data.

Methods

Using a subset of Truveta Data, we identified adult patients who underwent endoscopic sinus surgery between January 1, 2018, and August 31, 2026. Endoscopic sinus surgery was defined using relevant procedure codes. Endoscopic sinus surgery–coded visits occurring within 90 days of a prior surgery code were grouped as a single surgery, using the earliest date in each 90-day window (18). If any visit in the window included a computer-assisted navigation code, the surgery was classified as using navigation on that first surgery date. Computer-assisted navigation was identified using a specific add-on CPT code.

We evaluated the rate in which computer-assisted navigation was used in endoscopic sinus surgeries over time and examined utilization across demographics. We also assessed differences for patients with clinical characteristics, comparing computer-assisted navigation use among patients with diagnoses of acute recurrent sinusitis, chronic sinusitis, nasal polyps, nasal cysts, structural sinonasal disorders, asthma, or cystic fibrosis in the two years prior to surgery.

You can view the complete study, including data definitions and code, directly in Truveta.

Results

Across all 98,971 endoscopic sinus surgeries, computer-assisted navigation was used in 35.5% of surgeries. Computer-assisted navigation use increased from 29.2% in 2018 to 41.0% in 2026, which represents a 40.4% relative increase over the study period.

Line chart showing the percentage of endoscopic sinus surgeries performed with computer-assisted navigation from 2018 to 2026. Use of computer-assisted navigation increased overall from approximately 29% in 2018 to 41% in 2026. Adoption rose steadily through 2020, dipped slightly in 2021-2022, then increased consistently through 2026, reaching its highest level at the end of the study period. The chart indicates a growing use of computer-assisted navigation in endoscopic sinus surgery over time.

Clinical characteristics

Computer-assisted navigation use was higher among patients who had specific sinonasal or respiratory conditions, including acute recurrent sinusitis, chronic sinusitis, nasal polyps, nasal cysts, structural sinonasal disorders, asthma, and cystic fibrosis, in the two years before surgery

Bar chart comparing rates of computer-assisted navigation use during endoscopic sinus surgery among patients with and without selected clinical conditions in the prior two years. For every condition examined, navigation use was higher among patients with the condition than among those without it. The largest differences were observed for chronic sinusitis (about 50% vs. 15%), nasal cysts (about 46% vs. 13%), and nasal polyps (about 54% vs. 33%). Patients with acute recurrent sinusitis, structural nasal disorders, cystic fibrosis, and asthma also had higher rates of navigation use. A dashed reference line shows the overall average navigation use rate of approximately 38%. The chart suggests that computer-assisted navigation is used more frequently in patients with more complex sinonasal or respiratory conditions.

Age group

Computer-assisted navigation varied by age group. Computer-assisted navigation use was highest for patients aged 25-44 (37.8%) and those aged 45-64 (37.1%). It was lowest for the youngest (18-24 year-olds; 33.4%) and oldest age groups in our study (aged 65+; 32.0%).

Bar chart showing the percentage of endoscopic sinus surgeries performed with computer-assisted navigation by age group. Navigation use was highest among adults ages 25-44 (37.8%) and 45-64 (37.1%). Use was lower among younger adults ages 18-24 (33.4%) and lowest among adults ages 65 and older (32.0%). Overall, computer-assisted navigation was used at similar rates across age groups, with modestly higher utilization among middle-aged adults.

Discussion

Computer-assisted navigation use increased steadily from 2018 to 2026, consistent with broader adoption of navigation technologies in surgical practice (19–22). Increased availability of computer-assisted navigation systems, surgeon training, and evolving clinical guidelines supporting computer-assisted navigation in complex or higher-risk cases may contribute to this trend (14, 23–25).

Higher use of computer-assisted navigation among patients with chronic sinusitis, nasal polyps, prior inflammation, or structural abnormalities aligns with common insurance authorization requirements and professional society guidelines, which often recommend that computer-assisted navigation is appropriate when a case is more complex (15, 26). Age-related differences may relate to disease presentation, insurance coverage patterns, or referral pathways (27).

As technology evolves, the use of computer-assisted navigation may continue to increase. Innovations such as augmented reality overlays, enhanced imaging integration, and early development of AI-assisted navigation have the potential to expand the capabilities of intraoperative guidance systems (1, 13).

There are a few limitations associated with this analysis. Identification of computer-assisted navigation relied on the CPT add-on code being documented. If this code is missing or inconsistently captured, the data may underestimate how often navigation is used. This analysis includes all computer-assisted navigational technologies and did not differentiate among specific platforms or levels of technological advancement, and computer-assisted navigation systems may vary substantially between sites of care. Lastly, we did not distinguish between whether patients obtained prior authorization or insurance approval for navigation, which could influence whether the add-on code was billed.

Together, these findings highlight how computer-assisted navigation is being incorporated into current surgical practice and offer a clear picture of how its use has evolved in recent years. This analysis offers a glimpse into how advanced technologies are being adopted in clinical care today, though it represents only one of many such innovations.

These are preliminary research findings and not peer reviewed. Data are constantly changing and updating. These findings are consistent with data accessed on September 8, 2026.

Citations

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