Practical Aspects and Avoidance of Complications in Microendoscopic Spine Surgeries: A Review

Introduction Although the indications for endoscopic procedures have increased in recent times, there are also some limitations. This review discusses the practical points to prevent and treat complications in microendoscopic spine surgery. Material and Methods A literature search was conducted for the relevant articles after a topic search on PubMed, Google Scholar, and Medline. The review is based on the experience of 1,574 spinal endoscopic procedures performed by the senior author. Results Advantages of endoscopic surgery include better visualization, panoramic vision, and the ability to work around corners. Limitations with endoscopic procedures include proximal blind areas, obstruction in instrument handling due to a narrow corridor, disorientation, frequent lens fogging, loss of depth perception, and difficulty in achieving hemostasis, leading to complications and longer operative time during the learning curve. Conclusion Surgeons need to learn endoscopic skills in addition to microsurgical ones to perform microendoscopic procedures properly. Attending live workshops, watching operative videos, visiting various departments, watching an experienced and accomplished endoscopic surgeon, proper case selection, a multidisciplinary team approach, practicing on models, hands-on cadaveric workshops, laboratory training, and simulators can improve results and shorten the learning curve.

A Radiological Study of Anatomical Variations of Uncinate Process

ABSTRACT Aim (a) To study the variations in the superior attachment of uncinate process. (b) Incidence of pneumatization of uncinate process was also studied. Materials and methods A total 200 sides of 100 CT scans of paranasal sinuses coronal section were studied for variations in the superior insertion of uncinate process using Landsberg and Friedman classification. Incidence of pneumatization of uncinate process was also studied. Results In our study out of 200 sides, type 6 attachment was commonest (41%) followed by types 1 and 2. Pneumatization of the uncinate was seen in very small percentage of cases. Conclusion Lateral insertion of uncinate (lamina papyracea + aggar nassi) is the commonest variant followed by the insertion into the skulbase. Pneumatization of uncinate is rare. Clinical significance Though the inferior attachment of the uncinate is almost constant the superior attachment has several variations, the knowledge of which is very important for the endoscopic surgeon to avoid intraoperative complications. How to cite this article Patla SDK, Rathnakar P, Bhat VS, Jayaramesh. A Radiological Study of Anatomical Variations of Uncinate Process. Clin Rhinol An Int J 2016;9(2):59-61.

Anatomical Analysis of the Frontal Recess Cells in Endoscopic Sinus Surgery-An Indian Perspective

Surgery of the frontal sinus has gone a full circle from intranasal procedures to destructive and disfiguring external operations and now back to intranasal procedures but with endoscopes. Endoscopic surgery of the frontal sinus has always been a challenging experience because of the narrowness of the area, poor visibility, variable anatomy and encroachment by accessory cells such as agger nasi, frontal, intersinus septal cells on the drainage pathway. With the developments in optical aids such as endoscopes, which provide an angled view, better and brighter illumination, sophistication in the designs of instrumentation and development of imaging techniques, a renewed interest has been created in this area, but the knowledge of anatomy of this area is poor and does not meet the demands of the present day endoscopic surgeon. Moreover, no studies are available on Indian subjects. Our main interest in the present study was to study the various air cells which encroach the area of frontal recess and would need surgical removal to provide a good drainage and ventilation.

R428 – Evaluation of an Endoscope With an Ultra-wide Field of View

Problem The objective of this project is to establish if an advantage exists in using the C-View ‘trademark’ endoscope compared to a typical 0-degree Hopkins rod-lens telescope. The C-View ‘trademark’ endoscope is a novel design that provides a field of view up to ‘plus-minus’ 135-degrees about the optical axis and 360-degrees panoramically. Methods A cadaveric sheep glottis and trachea was examined using both a 4-mm Hopkins rod-lens telescope and a C-View ‘trademark’ endoscope (under development by Inter-Science, Inc., Troy, NY). At this time, the C-View ‘trademark’ endoscope prototype performs optical imaging only and does not include a means of internal illumination. Therefore, a separate external illumination source was used. Video taken during these examinations was analyzed and still images were obtained using the video editing software included with our stroboscopy tower (KayPentax Model 9295, Lincoln Park, NJ). Results The C-View ‘trademark’-based endoscope offers a sizable increase in field of view. Mucosal findings on the tracheal wall that could not be appreciated with the standard 0-degree model were readily apparent using this endoscope. Conclusion The C-View ‘trademark’ endoscope has enormous potential in the field of diagnostic endoscopy by creating a new working environment with an unmatched ultra-wide field of view. At this point, its use in living models or patients cannot be assessed without further development of the endoscope's illumination subsystem. Significance The true potential of this endoscopic system may not be fully realized until a prototype is developed which includes adequate illumination capabilities. Once perfected, this system will provide an enlarged field of view to any endoscopic surgeon or diagnostician. In the field of otolaryngology, this system has potential clinical relevance in many areas, including sinus endoscopy, laryngoscopy/tracheoscopy, esophagoscopy, and skull base surgery. Furture studies will assess manipulation of instruments in this new environment.

Anatomy of the Paranasal Sinuses for the Endoscopic Surgeon

Educational objectives: To understand the spatial relationships of the paranasal sinuses and lateral nasal wall, and to increase knowledge of the anatomic landmarks vital to the prevention of complications.