Patients are lightly sedated with IV medication and positioned comfortably on the operating table. The surgeon then locally numbs the skin surgical site to ensure the patient is comfortable throughout the surgery.
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Under fluoroscopic X-ray guidance, the physician guides a spinal needle and guidewire to the painful spinal disc. A micro-incision of ¼ inch is made. A metal dilator (the size of a pencil) and cannula are gently placed over the guidewire down to the spinal disc to establish the surgical portal. The guidewire and dilator are removed.
Specialized micro-instruments are placed through the endoscope to assist the surgeon in ablating and decompressing the affected spinal nerves. The surgeon often targets and resects herniated disc and bone spurs that may be impinging the spinal nerves.
Laser spine surgery is a marketing gimmick for many. Still, at DISC, our surgeons utilize a side-firing laser and radiofrequency energy often during ESS as one of many surgical instruments at their disposal.
After surgery, the spinal nerves are decompressed and free from impingement. A steroid injection is often administered thru the scope at the spinal level to enhance patient comfort and minimize post-operative inflammatory pain. The scope and cannula are removed, and one small stitch is used, applying a small bandage on the skin.
The aim of this study was to describe the surgical method of endoscopic conjunctivodacryocystorhinostomy with Jones tube insertion using a Castroviejo double-ended lacrimal dilator and to elucidate the surgical outcomes.
Under general anesthesia and preoperative epinephrine soaking, a monopolar needle cautery instrument was used to remove the nasal mucosa over the lacrimal and maxillary bone junction. After the lacrimal and maxillary bone junction was exposed, an oval osteotomy was formed. A Castroviejo double-ended lacrimal dilator was then inserted to create a direct fistula from the conjunctiva to the nasal cavity through the bony ostium. The dilator was grasped and withdrawn using smooth forceps to determine the tube length. The selected tube was then inserted into the fistula with a guide probe. Following removal of the probe, the inserted tube was fixed with 7-0 Ethilon suturing.
Among 39 patients, a total of 49 cases were examined. The success rate was 73.4% (36/49 eyes). The average surgical time was 29.1 minutes for single-eye operations and 47.3 minutes for double-eye operations. Lateral migration (6/13; 46.2%), medial migration (3/13; 23.1%), granulation tissue obstruction (2/13; 15.4%), inflammation (1/13; 7.7%), and malpositioning (1/13; 7.7%) were the noted complications that led to reoperation.
In conclusion, surgical management of endoscopic conjunctivodacryocystorhinostomy using a Castroviejo double-ended lacrimal dilator has several advantages. Using this device, easier surgical procedure, shorter surgical time, and more favorable success rate can be achieved without serious complications.
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