Instrumentation In Endoscopic Sinus Surgery Research Articles

Transnasal Endoscopic Approach to Symptomatic Sinonasal Osteomas

One of the most challenging benign tumors for the ear, nose, and throat (ENT) surgeon is represented by sinonasal osteomas. Surgical treatment should regard just symptomatic osteomas, because these tumors can provoke rhinosinusitis and mucoceles. Recently, new instruments have been applied in endoscopic sinus surgery (ESS). This study was designed to present our experience in the endoscopic management of osteomas of the paranasal sinuses. Clinical findings, preoperative imaging strategy, and surgical techniques are discussed. We retrospectively reviewed clinical records of patients who underwent ESS for sinonasal osteomas between 2003 and 2010 in our institutions. We have treated with a transnasal endoscopic approach 29 patients affected by paranasal osteomas (13 men and 16 women; age range, 20-78 years; mean, 49.5 years). We found frontoethmoidal junction localization in 14 patients, frontal sinus in 6 patients, ethmoid in 6 patients, sphenoid in 1 patient, maxillary in 1 patient, and multiple osteomas in 1 patient. Initially, patients were treated by the cavitation technique with standard ESS instruments, whereas in more recent cases surgery was assisted by the use of ENT navigation system, curved drills, and ultrasound bone emulsifier. No major complications occurred. No radiological or endoscopic signs of recurrence (mean follow-up, 52 months; range, 6-89 months) have been observed. Endoscopic removal of osteomas of the sinonasal region is feasible, taking into account the location and size of the lesion. Particular importance should be given to new instruments that have been applied in the last years in ESS.

Powered versus conventional endoscopic sinus surgery instruments in management of sinonasal polyposis

To conduct a prospective randomized controlled trial investigating the efficacy and safety of powered versus conventional endoscopic sinus surgery instruments in the management of sinonasal polyposis. Two hundred patients with sinonasal polyposis who failed conservative therapy were included in the study. They were equally randomized into powered and conventional instruments groups. A subjective visual analogue scale (VAS), endoscopic examination, saccharine clearance time and coronal CT were done preoperatively. Intraoperatively, the operative time, the surgical conditions and degrees of dryness of the operative field were carefully rated and recorded. Postoperatively, VAS, polyp grades, saccharine clearance time, the number of endoscopic debridement and time to mucosalization were recorded. Complications, smoothness of postoperative course were reported. Both groups experienced a significant improvement in the VAS with no statistically significant difference in symptom improvement between the two groups except for olfaction where there was significant improvement in the powered group. Similarly, the two groups demonstrated a significant improvement in the objective parameters including polyp grade and saccharine clearance time changes, but no significant difference between the two groups was found. The operative time as well as the surgical conditions and dryness of the operative field score were significantly better in the powered group. There was a tendency for improvement in the number of endoscopic debridement and time to mucosalization in powered group when compared to conventional instruments group, but this did not reach statistical significance. The incidence of postoperative synechiae was significantly lower in powered endoscopic group. Powered endoscopic sinus surgery offers a better therapeutic approach for patients with sinonasal polyposis when compared to endoscopic surgery with the conventional instruments. It provides a bloodless dry operative field with better visualization for a more precise, less traumatic procedure with minimal intraoperative complications and shorter operative time. Additionally, patients have a smoother postoperative course, less incidence of synechiae, with a tendency for a faster healing.

Using human reliability analysis to detect surgical error in endoscopic DCR surgery.

The aim of this study was to describe the nature of active skill-based errors occurring in endoscopic dacrocystorhinostomy (DCR) surgery. A human reliability analysis methodology was used to assess surgical error from observational capture data. Twelve endoscopic DCR operations performed by three different surgical trainees were video recorded. The steps (subtasks) of each operation were carefully analysed and common errors were documented. Specific errors that resulted in trauma to the nasal mucosa were noted. Execution errors were common, with errors of grasping being most frequent (67% of all execution errors). Most of these involved the Blakesley forceps. In total, there were 69 mucosal trauma hits. Inserting instruments into or withdrawing them from the nasal cavity with too much force or speed caused more than half of these. Incising with too much force resulting in 'overshoot' caused 34% of mucosal trauma. Trainee ENT surgeons should take particular care when inserting or withdrawing instruments from the nasal cavity and also when performing lacrimal sac or nasal mucosa incisions. Performance of these tasks with too much force was identified as a common and potentially avoidable cause of mucosal trauma. Further research is needed into the design and use of endoscopic sinus surgery instruments with the aim of avoiding the errors that were encountered.

Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks.

To analyze possible etiological factors of spontaneous cerebrospinal fluid (CSF) rhinorrhea and to assess the outcomes of endonasal endoscopic repair. Retrospective study. Academic neurosurgical hospital. Patients Twenty-one consecutive patients who presented with spontaneous CSF leak and underwent endonasal endoscopic surgery from January 1999 through December 2001. Preoperative examination included computed tomographic scans; nasal endoscopy; measurement of glucose concentration in the nasal discharge; and, in some cases, cisternographic evaluations via computed tomography and/or magnetic resonance imaging. Telescopes, conventional endoscopic sinus surgery instruments, and a microdebrider were used for all patients who underwent endonasal surgery. A combination of plastic materials, ie, abdominal fat, fascia lata, rotated middle turbinate flaps, and fibrin glue, were used for fistula repair. At the time of surgery, CSF fistulas were found in the cribriform plate (6 patients), in the fovea ethmoidalis (6 patients), and in the sphenoid sinus (9 patients). In 5 of the 6 patients who had an extremely pneumatized sphenoid sinus, the source of the leak was located in the lateral extension of the sinus. A meningocele protruding through the bone defect was the source of the leak in 10 patients. Postoperative follow-up lasted from 9 to 42 months, and 20 patients were considered cured. There was only 1 recurrence, in a patient whose CSF rhinorrhea originated in the deep lateral recess of an overpneumatized sphenoid sinus. Thus, the overall success rate was 95.2%. There were no postoperative complications. Possible etiological factors of this disease include obesity, congenital malformations of the skull base, an overpneumatized sphenoid sinus (particularly in its lateral extensions), and the empty sella syndrome. Endoscopic endonasal repair of spontaneous CSF rhinorrhea appears to be a safe and successful procedure. However, techniques for endoscopic closure of CSF fistulas in the lateral part of the sphenoid sinus need further perfecting.

Sphenoid marsupialization for chronic sphenoidal sinusitis.

To review experience with sphenoid marsupialization and describe the technique using new instrumentation. Retrospective review of five cases of chronic sphenoid sinusitis that were resistant to standard medical and surgical methods, which were treated by sphenoid marsupialization. Charts were reviewed and patients were interviewed regarding postoperative resolution of symptoms. Five cases of recalcitrant sphenoid sinusitis were reviewed. All patients had headache before surgery, and two had visual disturbance. In follow-up ranging from 1 to 87 months, all were free of symptoms related to the sphenoid sinus. Marsupialization is an effective method of exteriorizing a chronically infected sphenoid sinus. The use of functional endoscopic sinus surgery instruments and the TAC attachment of the Midas Rex drill make this surgery possible.

Power instrumentation in endoscopic sinus surgery

Power instrumentation is gaining widespread use 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 burs are protected by a sheath that can also protect the back side of the bur. 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 article, 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 modified transnasal Lothrop procedure or frontal drillout, endoscopic septoplasty, and choanal atresia repair.

Instrumentation in endoscopic sinus surgery: current surgery techniques

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.

The Hummer: A Remedy for Apprehension in Functional Endoscopic Sinus Surgery

New instrumentation for endoscopic sinus surgery is presented as a remedy for surgical apprehension. The precision of the device coupled with the delivery of real-time suction are the major advantages over other techniques. The importance of an understanding of the variables of the device, especially with respect to suction, is emphasized. A systematic approach to the surgery is presented that permits an anatomical, minimally invasive technique resulting in quicker healing for the patient and an increased comfort level for the surgeon.

Powered Instrumentation in Functional Endoscopic Sinus Surgery II: A Comparative Study

The present paper compares the use of the microdebrider as a form of powered instrumentation for endoscopic sinus surgery with traditional endoscopic surgical techniques. A group of 250 patients undergoing surgery with the microdebrider was compared with a group of 225 patients undergoing traditional procedures in order to evaluate their postoperative recovery, healing, and incidence of complications. The use of the microdebrider demonstrated faster healing with less crusting than standard techniques, as well as decreased bleeding, synechia formation, lateralization of the middle turbinate, and ostial reocclusion. The microdebrider offers excellent surgical results with fewer complications and faster healing than traditional techniques in functional endoscopic sinus surgery.

Instrumentation for Endoscopic Sinus Surgery

Instrumentation for Endoscopic Sinus Surgery

Endoscopic dacryocystorhinostomy

Recent advances in the instrumentation for endoscopic sinus surgery have resulted in the development of endoscopic dacryocystorhinostomy procedures. The position of the lacrimal duct can be precisely located with a light pipe placed through the punctum into the lacrimal sac. Curets and small drills allow for precise removal of the lacrimal bone over the lacrimal duct. The sickle knife can then be used to transect the lacrimal duct. Lacrimal stents can then easily be placed through the lacrimal ducts and into the nose. Stents are usually left in place for several months and removed by the ophthalmologist. Endoscopic dacryocystorhinostomy offers the opportunity to perform the procedure with minimal risk and trauma to the surrounding tissues.