Abstract
The endoscope has become an essential tool for transsphenoidal pituitary surgeries because of the panoramic view and the ability to visualize structures beyond the direct line of vision. However, the regular dedicated instruments for these surgeries sometimes do not reach the areas visualized by an angled endoscope, and instrument maneuverability is limited. To overcome or minimize these problems, we constructed a new flexible tumor forceps that can be manipulated to change shape after placing into the surgical fields via the endonasal or sublabial route, to reach any desirable location for tumor dissection and excision. We applied this newly developed instrument in endonasal endoscopic resection complementing microsurgical procedure in 20 cases of pituitary tumors. The flexible forceps was able to access sites where regular dedicated instruments for transsphenoidal pituitary surgeries could not readily reach despite endoscopic visualization. No complication was observed in the present series, confirming the safety of the newly designed flexible forceps. Our newly developed flexible forceps improves the instrument maneuverability of endoscopic transsphenoidal resection of pituitary tumors, especially those located laterally at the cavernous sinuses or with frontal extension. The use of this instrument makes the best use of endoscopic panoramic visualization for tumor removal.
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Alessandro Ducati, Turin, Italy
The authors describe a useful instrument (flexible forceps, operated by one hand only) that matches the angled view offered by endoscopes. This tool is primarily meant for transnasal pituitary surgery, where it allows eliminating small remnants of adenoma in the “blind to microscope” sites; moreover, it can possibly find also different applications for “beyond the corner” tumor removal. I think that this technical improvement is in the line of a better instrument design, required by the increased visualization allowed by new microscopes and endoscopes and by the enhanced requirement of radical removal in tumor surgery. We will observe several such new tools in the next future.
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Kawamata, T., Amano, K. & Hori, T. Novel flexible forceps for endoscopic transsphenoidal resection of pituitary tumors: technical report. Neurosurg Rev 31, 65–68 (2008). https://doi.org/10.1007/s10143-007-0108-2
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DOI: https://doi.org/10.1007/s10143-007-0108-2