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Assessing the rhinological outcome and surgical footprint of the chopstick technique in endoscopic transsphenoidal pituitary adenoma surgery
EANS Academy. Serra C. 09/26/19; 276083; EP04062
Dr. Carlo Serra
Dr. Carlo Serra

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Abstract
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Background: The 'chopsticks' technique, introduced by Professor Froelich, is a three-instruments, two hands, mononostril technique where the operating surgeon holds the endoscope with the non-dominant hand together with the suction, whilst holding the working instrument with the dominant hand. This approach allows for a dynamic surgical view controlled by only one surgeon without completely losing the advantages and safety of a bimanual dissection. This technique can be performed through a purely mononostril approach, thereby eliminating the manipulation of the second nasal cavity and thus reducing surgical footprint.
Objective: To assess the rhinologic footprint of the 'chopsticks' technique in a serie of patients undergoing transsphenoidal endoscopic surgery (TSS) for pituitary adenoma.
Methods: Cohort analysis of prospectively collected data on 152 nonconsecutive operations undergoing TSS using the 'chopsticks' technique. All patients had at least 3 months postoperative neurosurgical, endocrinological and rhinological follow-up (SNOT-20 and sniffin test). Patients` clinical outcome, extent of resection and complications are descriptively reported.
Results: Gross total resection (GTR) was achieved in 72.4% of cases at the 3 month postoperative MR, with an average extent of resection (EOR) of 97.0%. The operation resulted in endocrine remission in 85.0% of patients with secreting adenomas. There was no mortality and only 1 case of permanent new quadrantanopsia. As of the final follow-up, 12% had a new pituitary deficit whereas 26% had seen an improvement. There was only 2 case of postoperative severe hyposmia and 1 case of severe impairment of nasal quality of life (SNOT-20 > 40).
Conclusion: The chopstick technique with 3T-iMR allows a single surgeon to perform effective endoscopic bimanual dissection through a single nostril without unnecessary manipulation of healthy tissue thereby minimizing surgical footprint. We showed that this surgical technique offers resection results which compare favorably with literature on adjunctive morbidity.
Background: The 'chopsticks' technique, introduced by Professor Froelich, is a three-instruments, two hands, mononostril technique where the operating surgeon holds the endoscope with the non-dominant hand together with the suction, whilst holding the working instrument with the dominant hand. This approach allows for a dynamic surgical view controlled by only one surgeon without completely losing the advantages and safety of a bimanual dissection. This technique can be performed through a purely mononostril approach, thereby eliminating the manipulation of the second nasal cavity and thus reducing surgical footprint.
Objective: To assess the rhinologic footprint of the 'chopsticks' technique in a serie of patients undergoing transsphenoidal endoscopic surgery (TSS) for pituitary adenoma.
Methods: Cohort analysis of prospectively collected data on 152 nonconsecutive operations undergoing TSS using the 'chopsticks' technique. All patients had at least 3 months postoperative neurosurgical, endocrinological and rhinological follow-up (SNOT-20 and sniffin test). Patients` clinical outcome, extent of resection and complications are descriptively reported.
Results: Gross total resection (GTR) was achieved in 72.4% of cases at the 3 month postoperative MR, with an average extent of resection (EOR) of 97.0%. The operation resulted in endocrine remission in 85.0% of patients with secreting adenomas. There was no mortality and only 1 case of permanent new quadrantanopsia. As of the final follow-up, 12% had a new pituitary deficit whereas 26% had seen an improvement. There was only 2 case of postoperative severe hyposmia and 1 case of severe impairment of nasal quality of life (SNOT-20 > 40).
Conclusion: The chopstick technique with 3T-iMR allows a single surgeon to perform effective endoscopic bimanual dissection through a single nostril without unnecessary manipulation of healthy tissue thereby minimizing surgical footprint. We showed that this surgical technique offers resection results which compare favorably with literature on adjunctive morbidity.
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