Experience with a new micro-applicator for laser surgery of recurrent polypous sinusitis

摘要

Laser surgical methods as an alternative to conventional surgery for the treatment of recurrent chronic polypous sinusitis have been widely established over the past few years. While feedback-controlled contact laser application causes little disruption to the tissue, the minimal-invasive approach is limited by the accessibility of recurrent polyps. We employ a semi-rigid applicator for the guidance of the laser fiber with an outer diameter of 4 mm, whose tip can be adjusted and fixed in a flexible manner before or while accessing the operative field. In addition to the laser fiber channel, two further integrated channels can be used for laser plume suction and for introducing a flexible micro-endoscope with an outer diameter of 1.3 mm. This new device enables the surgeon to apply laser energy in close proximity to an endoscope and smoke suction channel even in regions with limited accessibility, such as the maxillary sinus bottom or the frontal sinus recess. The single-handed use facilitates maneuvering this device in narrow endona-sal cavities. The integrated micro-applicator presented here widens the scope of operative options for endonasal laser surgery. In addition to a better access to all regions of the paranasal sinuses following conventional endonasal sinus surgery, its use for treating locally limited chronic polypous sinusitis via natural drainage pathways as a primary surgical procedure bears considerable potential for further evaluation.