목적: Kaolin-impregnated gauze (KIG) facilitates rapid hemostasis by activating the intrinsic coagulation pathway via Factor XII, promoting fibrin clot formation and platelet aggregation. While its use is well- documented in cardiac, ophthalmic, and laparoscopic surgeries, its role in endoscopic sinus surgery (ESS), where effective hemostasis is crucial for maintaining visualization, remains unexplored. This study evaluates the clinical utility of KIG in ESS by comparing surgical times between cases using KIG and conventional gauze. 방법:A retrospective review of 1,317 patients who underwent ESS between January 2022 and December 2024 was conducted, from which only complex ESS cases were selected for analysis. Complex cases were defined as procedures involving three or more sinuses, polypectomy for diffuse polyposis, or revision surgeries. The extent of surgery was categorized based on sinus involvement: maxillary (M), ethmoid (E), frontal (F), and sphenoid (S), with procedural combinations denoted by their respective sinus initials (e.g., EM, EMF, EMFS). Patients were categorized by surgical approach (bilateral or unilateral) and whether septoplasty was performed. A surgical time was considered a surrogate marker for both hemostatic effectiveness and visualization quality. Surgical time was compared between groups based on KIG use, considering differences between unilateral and bilateral approaches in individual ESS techniques and whether concurrent septoplasty was performed. Additionally, postoperative vascular complications were reviewed to assess the safety of KIG. 결과:A total of 561 patients undergoing complex ESS were analyzed, with 331 receiving KIG and 230 treated with conventional gauze. Multivariate regression analysis showed that KIG use was associated with a mean surgical time reduction of 7.33 minutes (p = 0.001). Bilateral procedures (+23.68 min, p < 0.001) and the addition of septoplasty (+25.40 min, p < 0.001) were the most significant factors in prolonging surgical time. ANOVA analysis showed that KIG significantly reduced surgical time in complex EMF (p = 0.031) and complex EMFS (p = 0.024) cases, but not in complex EM (p = 0.092). No thromboembolic events or vascular complications were observed. 결론:The KIG significantly reduced surgical time in complex ESS cases, particularly in EMF and EMFS procedures, without thromboembolic or coagulation-related complications. Given its safety and hemostatic efficacy, KIG may serve as a valuable adjunct in sinus surgery.