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Prevention of blood staining of endoscope tip during functional endoscopic sinus surgery: sleeve technique

Published online by Cambridge University Press:  23 June 2009

G Kalra ,
J Keir  and
J Tahery
G Kalra*
Affiliation:
Department of Otolaryngology, Countess of Chester National Health Service Foundation Trust, Chester, Cheshire, UK
J Keir
Affiliation:
Department of Otolaryngology, North Cheshire Hospitals National Health Service Trust, Warrington, Merseyside, UK
J Tahery
Affiliation:
Department of Otolaryngology, Countess of Chester National Health Service Foundation Trust, Chester, Cheshire, UK
*
Address for correspondence: Ms Guneet Kalra, Department of ENT, Countess of Chester Hospital, Chester CH2 1UL, UK. Fax: 01244366423 E-mail: docguneetk@yahoo.co.uk
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Abstract

Optimisation of the endoscopic view during FESS may require correction of a deviated septum. The resulting incision leads to bleeding which could obscure the view of the endoscope. Repeated cleaning of the endoscope intraoperatively is time consuming and traumatisation of the lining of the nasal mucosa may lead to formation of adhesions post operatively.

We discuss the use a segment of suction tubing that can act as a conduit or sleeve for the passage of the endoscope into the nasal cavity. This protects the endoscope tip from the bleeding area.

Keywords

Paranasal SinusesEndoscopyOtorhinolaryngologic Surgical Procedures
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 12 , December 2009 , pp. 1358 - 1359
Copyright
Copyright © JLO (1984) Limited 2009

Introduction

During functional endoscopic sinus surgery (FESS), correction of a deviated septum may be required in order to optimise the surgical view.Reference Cantrell1 However, incision of the septal wall can lead to troublesome bleeding. The passage of an endoscope through this area may result in the endoscopic view being obscured by blood.

We present a simple technique with which to bypass such bleeding, using a 1–1.5 cm section of suction tubing as a conduit through which the endoscope is passed, thereby protecting it from the bleeding site.

Methods and materials

Firstly, a 2–2.5 cm length of 0.5 cm diameter suction tubing is cut, and this segment is introduced into the nasal vestibule (Figure 1).

Fig. 1 Cut sleeve of suction tubing.

This length of tubing acts as a conduit or sleeve for the passage of the endoscope into the nasal cavity, and protects the endoscope tip from the bleeding area (Figure 2).

Fig. 2 Endoscope passed through the suction tubing sleeve.

With the suction tubing in situ, it is still possible to pass other instruments into the nasal cavity, in addition to the endoscope. These are introduced beneath the suction tubing.

Discussion

Intra-operative bleeding from the nasal mucosa can be decreased using adrenaline-soaked ribbon gauze or neuropatties and haemostatic agents such as surgicel. In our practice, these measures are ineffective and require a period of inactivity while waiting for haemostasis. We have found the described suction tubing sleeve technique to be a simple, safe method which saves time when managing troublesome nasal mucosal bleeding during FESS.

The sleeve technique also facilitates the teaching of juniors. This technique both enhances the surgical view (Figure 3) and bypasses bleeding from the nasal vestibule, making the procedure technically easier to perform for inexperienced operators.

Fig. 3 View of the nasal cavity through the suction tubing sleeve.

References

1Cantrell, H. Limited septoplasty for endoscopic sinus surgery. Otolaryngol Head Neck Surg 1997;116:274–7CrossRefGoogle ScholarPubMed
Figure 0

Fig. 1 Cut sleeve of suction tubing.

Figure 1

Fig. 2 Endoscope passed through the suction tubing sleeve.

Figure 2

Fig. 3 View of the nasal cavity through the suction tubing sleeve.