Instrumentation in endoscopic sinus surgery: current surgery techniques

Abstract

The use of power instrumentation is gaining widespread usage in endonasal endoscopic surgery. The exacting nature of soft tissue and bone removal in a confined anatomic area with adjacent important anatomic structures lends itself for consideration of anatomic contouring with these instruments. The soft tissue shaving cannulas and new bone-cutting drills embody a potentially less traumatic and more precise method of soft tissue extraction and bone removal. The soft tissue shaving cannula consists of a blunt cannula with an inner oscillating cutting blade that precisely cuts and extracts tissue as it is gently sucked through the side port of the cannula. The shafts of the bone-cutting burrs are protected by a sheath that can also protect the back side of the burr. Suction is applied through the sheath, which provides for a clear surgical field. The increased precision, the ability to keep the endoscopic field clear of blood and debris, and the ability to precisely and safely drill bone endonasally may allow for the more widespread application of minimally invasive approaches to a variety of clinical problems. In this report, we describe the soft tissue shaver in the surgical treatment of severe polyposis, periorbital abscess secondary to sinusitis, and other clinical situations in which increased surgical bleeding is to be expected, as well as for routine endoscopic sinus surgery. We discuss applications of the bone-cutting drills, including the modified transnasal Lothrop procedure or frontal drillout, endoscopic septoplasty, and choanal atresia repair.