Abstract
Background
The endoscopic diving technique (EDT) is a procedure utilized in endonasal endoscopy, which consists of irrigating the surgical cavity during tumor removal, with a continuous flow of pressurized saline solution.
Methods
The authors provide a detailed step-by-step description of the technique, shedding light on surgical tips and pitfalls. Advantages, disadvantages, and the most useful application of the technique are clarified and showed with a high-quality endoscopic video.
Conclusion
EDT represents an effective and safe procedure. It allows a wide exploration of the surgical cavity, providing tumor hydro-dissection, assisting in bleeding control, and optimizing the efficacy of endoscopic transsphenoidal surgery.
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Abbreviations
- EDT:
-
Endoscopic diving technique
- CSF:
-
Cerebrospinal fluid
References
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The authors declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Key points
• EDT consists of irrigating the surgical cavity during or after tumor removal, with a continuous flow of pressurized saline solution and entering inside it with the endoscopic probe;
• Water is propelled by an irrigating pump system connected to endoscope lens cleaner system;
• EDT provides visual magnification and enables to navigate inside the surgical cavity;
• It allows to hydro-dissect the lesions and clearance of tumor remnants;
• The intra-cavity pressure counterthrusts venous bleeding and promotes blood clots removal;
• EDT enables the re-expansion of the suprasellar cistern, looking for tumor residues inside “hidden zones” like the parapituitary recesses;
• It is particularly effective dealing with sellar-, parasellar-, and suprasellar-located tumors;
• Water pressure can be adjusted according to needs;
• It can be less effective in case of hard consistency lesions or scar tissue in tumor relapses;
• EDT is a cheap solution that requires only a bag of warm saline solution to work!
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Locatelli, D., Balbi, S. & Veiceschi, P. The endoscopic diving technique in endonasal transsphenoidal surgery: how I do it. Acta Neurochir 162, 2111–2114 (2020). https://doi.org/10.1007/s00701-020-04369-8
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DOI: https://doi.org/10.1007/s00701-020-04369-8