• Moujahed Labidi, Kentaro Watanabe, Shunya Hanakita, Hun Ho Park, Schahrazed Bouazza, Anne-Laure Bernat, and Sébastien Froelich.
• Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France; Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada. Electronic address: Moujahed.l@gmail.com.
• World Neurosurg. 2018 Sep 1; 117: 208-220.

BackgroundVariations and additions to the endoscopic endonasal exposure have been proposed around a modular strategy. These extensions are often necessary to provide additional working space and reduce conflict between the instruments and the endoscope. Resection of endonasal structures, which affects negatively the sinonasal quality of life, is thus undertaken not only to obtain tumor exposure but also to improve the maneuverability of the instruments.ObjectiveOur objective was to achieve the same skull base exposures and tumor resections and limit the surgical footprint on sinonasal structures and patients' quality of life.MethodsOur team developed a surgical technique in which the endoscope and a malleable rotative aspirator are held by the nondominant hand and the other main instrument in the dominant hand. This modification, which we call the chopsticks technique, allows the surgeon to use minimalistic exposures with an improved dynamic perception of the surgical field and reduced conflicts between the instruments. The endonasal structures that are left intact help support the instruments. The same surgical objectives, in terms of exposure and resection, are achieved. We describe our technique and a series of patients operated with this uninarial 3-instruments technique to discuss relevant operative nuances.ConclusionsWe propose a technical modification that allows the surgeons to benefit from the advantages of a bimanual technique while still holding the endoscope. In our opinion, this technique may improve dynamic understanding of the anatomy and surgical efficiency and reduce the footprint of the surgery.Copyright © 2018 Elsevier Inc. All rights reserved.

31 keywords...

hide…