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Transcanalicular endoscopic laser assisted dacryocystorhinostomy
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The next step is laser osteotomy and this is done using a 980 nanometer diode laser. The laser is first fired in pulsed mode starting from the lower part of the lacrimal fossa. The bone in this part is thin thus the bone ablation is first carried out in the inferior part.
The diode laser setting is used at an average of 10W with continuous laser delivery using the contact mode.
The continuous back and forth motions are made with the laser fibre. This window is gradually enlarged superiorly. The laser is fired at 10W in continuous contact mode and once the bony window is created, the secretions can be seen flowing into the nose.
As demonstrated in this schematic diagram the, The advantage of a semirigid probe is that a hard stop, can be felt constantly during the surgery. It ensures that the tip of the laser probe is in the sac and does not slip into the canaliculi when the laser is fired and it thus, ensures canalicular safety.
Once an adequate size window is made the lacrimal sac lumen is examined (Figs. 16.18 and 16.19). A favourable case is the one where the lumen is clear with smooth lining of the mucosa indicating a distal NLD obstruction.
Keywords
- Diode laser
- Transcanalicular endoscopic laser dacryocystorhinostomy
Conflict of Interest
The author declares no conflict of interest.
About this video
- Author(s)
- Nishi Gupta
- First online
- 06 August 2021
- DOI
- https://doi.org/10.1007/978-981-16-2645-6_7
- Online ISBN
- 978-981-16-2645-6
- Publisher
- Springer, Singapore
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021
Video Transcript
The next step is laser osteotomy. A 980-nanometer diode laser is first fired and pulse mode. Any smoke generated in the nasal cavity is cleared. Bone ablation starts from the lower part as the lower part of the fossa is thinned and a bony window is created. Diode laser setting used is an average of 10 watt, with continuous laser delivery using the contact board. Continuous back and forth motions are made with the laser fiber, and the window is gradually enlarged superiorly.
Once the bony window is created, the secretions can be seen flowing into the nose. And as demonstrated in this schematic diagram, the advantage of using a semi-rigid probe is that a hard stop can be felt constantly during the surgery. It ensures that the tip of laser probe is in the sac and it does not slip into the canalicula when the laser is fired, and it thus ensures canalicular safety.
This is the superior part of the lacrimal sac, and multiple holes are created with the laser to ensure that a wide opening is created in this part. It may not be possible to ablate large chunk of bone with the laser, so multiple windows are created and those windows are then joined. We can see the secretions trickling all along the windows that were made into the lateral wall. As the laser probe enters into the nose, we stop firing the laser to prevent injury to these structures. The probe is pulled back, and the obstructions are felt, or the intervening area between the bony windows are felt, and the bone is ablated so that the windows can be joined. All those openings made on the lateral wall are gradually joined.
A ball pointer is inserted into these windows to check the continuity of all the windows. Any gaps left in between are again ablated. The middle turbinate is protected all the time. That’s the laser tip that we can see through the window created superiorly. So we can see this whole window from superior to the inferior end of the lacrimal sac and nasolacrimal duct. Medial canthal area is pressed to empty the sac of any secretions. That can be seen flowing into the nose. That’s the lacrimal sac lumen.