When anatomic abnormalities of the nose and sinuses contribute to sinusitis, and when medical therapy has failed, these anatomic or structural abnormalities can be surgically corrected. Examples of anatomic problems include nasal polyps, nasal septal deviations, and blockage of the osteomeatal complex--the "crossroads" of the sinuses. Endoscopic techniques allow sinus specialists to diagnose and treat these problems more easily than in the past, allowing them to be more proactive in the management of anatomic nasal abnormalities. In this article we review the minimally invasive, endoscopic approach to sinus surgery and discuss recent advances in sinus surgery. Specifically, we discuss the utility of powered instrumentation and image guidance in endoscopic sinus surgery.