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J Neurol Surg B Skull Base
DOI: 10.1055/a-2065-9300
Original Article

Multiportal Retrograde Endoscopy to Enhance Surgical Target Visualization: A Pilot Study

Neeraja Konuthula 
1   Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, Washington, United States
,
Randall A. Bly
1   Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, Washington, United States
2   Division of Pediatric Otolaryngology – Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, United States
,
Waleed M. Abuzeid
1   Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, Washington, United States
,
Ian M. Humphreys
1   Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, Washington, United States
,
Vanessa V. Masco
2   Division of Pediatric Otolaryngology – Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, United States
,
Blake Hannaford
3   Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, United States
,
Kris S. Moe
4   Otolaryngology-Head & Neck Surgery, Harborview Medical Center, Seattle, Washington, United States
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Abstract

Objective Current transnasal endoscopic techniques for sinus and skull base surgery use a single endoscope to provide visualization from one perspective curtailing depth perception and compromising visualization of the instrument–target interface. The view can be blocked by instruments, and collisions between instruments often occur. The objective of this study was to investigate the use of multiportal retrograde endoscopy to provide more accurate manipulation of the surgical target.

Design Maxillary antrostomy and frontal sinusotomy were performed on three different cadavers by three different surgeons. A zero-degree rigid endoscope was introduced through the nose for the standard transnasal approach. A flexible endoscope was introduced transorally, directed past the palate superiorly, and then flexed 180 degrees for the retrograde view. Videos of the standard transnasal view from the rigid endoscope and retrograde view from the flexible endoscope were recorded simultaneously.

Results All surgeries were able to be performed with dual-screen viewing of the standard and retrograde view. The surgeons noted that they utilized the retrograde view to adjust the location of ends/tips of their instruments. Four surgeons reviewed the videos and individually agreed that the visualization achieved provided a perspective otherwise not attainable with rigid transnasal endoscopy alone.

Conclusion High-quality visualization of surgical targets such as the frontal or maxillary ostia can be challenging with rigid endoscopes alone. Multiportal retrograde endoscopy provides proof of concept that additional views of a surgical target can be achieved. Additional work is needed to further develop indications, techniques, and generalizability to targets beyond those investigated here.

Keywords

sinus and skull base surgery - multiportal - reverse perspective endoscopy - endoscopic surgery


Publication History

Received: 19 December 2022

Accepted: 27 March 2023

Accepted Manuscript online:
30 March 2023

Article published online:
31 May 2023

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