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.
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
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.