TRANSNASAL ENDOSCOPIC SURGERY - Dr. P. THULASI DAS
The most significant
advances in medicine in this century have been the discovery of
antibiotics, the invention of various computerised scans and
endoscopy of the various body cavities. Endoscopes are used in many
branches of medicine today, so much so, there is no body cavity one
cannot have a look into. Since endoscopes are widely available, the
birth of keyhole surgery, where the operation is carried out through
a small opening using endoscopes and special instruments, was only a
matter of time. Keyhole surgery is becoming increasingly popular
since it reduces the patient morbidity to a large extent, and avoids
large unsightly scars. The endoscopes used for nasal sinus endoscopy
are rigid tubes consisting of rod lenses. The optical system which
was developed by Prof. H.H.Hopkins telescopes are small in diameter,
but have larger viewing angles and transmit brighter light. They are
available in 4mm and 2.7mm diameters and are 18cm in length. Also
telescopes with different viewing angles at the tip to view the
sides and back are available. Thus by exchanging different angled
telescopes one gets a side view and a retrograde view. For
photography and documentation these telescopes are ideal. The
clarity of vision through these telescopes is far more superior than
the flexible fiber optic scopes.
Traditionally, the
examination of the nose and sinuses have been fraught with
difficulties. The reason is, the nose opens to the exterior through
very small openings, but inside it expands into a large cavity
measuring about 7cm long, 2.5 cm wide and 5cm high. Passing light
through the narrow external opening and also viewing through the
same opening have always been difficult.
Click below image to enlarge view
Bottle neck at the external
nasal aperture does not allow enough light entry, when an
external source of light is used.
Moreover, with
conventional examination methods, the amount of light entering the
nasal cavity is very little and it is not possible to get
satisfactory view of the rear portions of the nose, nasopharynx and
sinuses.
For this reason, the
back half of the nose, nasopharynx and the sinuses are traditionally
regarded as occult areas and a cancer or benign tumour could remain
hidden in these sites for a long time. The nasal endoscope does the
twin job of carrying light into the nasal cavity and the image back
to examiner. Using the nasal endoscope it is possible to visualize
each and every millimeter of the nasal cavities and nasopharynx
Click below image to enlarge view
Bottle neck at the external nasal aperture is overcome by endoscopes and the nasal cavity has become a surgical highway.
.
Moreover it occupies only little space at the external openings of
the nose, hence allows surgical instruments to be the passed
along-side the scope.
More recently a
technique of performing surgery using the endoscopes has been
developed in Austria and Germany. This technique takes advantage of
the better illumination and vision provided by the Endoscope.
Special instruments developed for the purpose are passed alongside
the endoscope into the nose and operations carried out using key
hole surgery principle. Though the idea was conceived and early work
was done by Prof. Messerklinger of Graz, Austria. Prof.H.Stammberger
is the one who popularized Endoscopic sinus surgery in the English
speaking world.
The disease conditions
most benefited by this surgery are long standing sinusitis not cured
by medical treatment , loss of smell, polyps and rhinosporidium,
bleeding from the nose and cysts filled with mucous in the sinuses.
Today everything inside the nose is done by endoscopes in our
clinic. The diseases considered incurable hitherto has become
curable. The surgical procedures given up due lack of illumination
and vision, has been revived. Not only diseases of the nose and
sineses are tackled with endoscopes, diseases of the orbit,
pituitary and skull base are also tackled by transnasal Endoscopic
surgery, so much so Transnasal Endoscopic Surgery has become a
speciality by itself. The nose has become a surgical highway, and
Transnasal Endoscopic surgery has broken the man made barriers
separating the various specialities in the head and neck area.
