Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Otol Neurotol. 2014 Jan;35(1):101-7. doi: 10.1097/MAO.0b013e3182a446bc.
One-handed endoscopic procedures have, up until now, limited the indications for transcanal endoscopic ear surgery (TEES) in cholesteatoma surgery. However, the development of electrically powered instruments has opened the door to such one-handed endoscopic procedures in restricted surgical spaces.
We examined the feasibility of using one such powered instrument, the ultrasonic bone curette (UBC) in TEES for cholesteatoma surgery. The UBC offers several advantages, including nonrotational motion and the combination of both suction and irrigation in a single handpiece.
A prospective case series.
Tertiary referral center.
TEES was performed on 43 cases of primary cholesteatoma between September 2011 and December 2012, including 14 cases extending to the antrum.
Zero-, 30-, or 70-degree angled rigid endoscopes with an outer diameter of 2.7 mm (Karl Storz) were used together with a high-definition video system. A Sonopet UBC (Stryker) was used to cut bony tissue. The nonrotational motion of the UBC prevents injury to the tympanomeatal flap and other soft tissue, which may result with standard drills. Transcanal endoscopic retrograde mastoidectomy on demand was performed to access the pathologies in the attic and antrum.
A minimum attico-antrotomy was performed using the UBC, removing only the bony tissue necessary to visualize the pathology. The cholesteatoma was completely removed from the antral mucosa under clear endoscopic visualization in 13 of 14 cases. After removal of the cholesteatoma, the canal wall was reconstructed using cartilage taken from the tragus. This procedure resulted in greater mastoid preservation.
The transcanal endoscopic approach to the antrum using the UBC proved to be less invasive and more functional. The UBC contains both a suction and irrigation system in a single handpiece, and this UBC is an appropriate cutting tool that extends the indications for TEES.
单手内镜手术在以往限制了经耳道内镜耳科手术（TEES）在胆脂瘤手术中的应用指征。然而，电动仪器的发展为在有限的手术空间中进行单手内镜手术提供了可能。
我们研究了电动超声骨锉（UBC）在 TEES 中用于胆脂瘤手术的可行性。UBC 具有许多优势，包括非旋转运动以及在单个手柄中同时结合抽吸和冲洗。
前瞻性病例系列。
三级转诊中心。
2011 年 9 月至 2012 年 12 月，对 43 例原发性胆脂瘤患者行 TEES，其中 14 例延伸至窦腔。
使用外径为 2.7 毫米的 0 度、30 度或 70 度刚性内窥镜（Karl Storz）和高清视频系统。使用 Sonopet UBC（Stryker）切割骨组织。UBC 的非旋转运动可防止对鼓膜-鼓环瓣和其他软组织的损伤，这可能会导致使用标准钻头时发生损伤。按需行经耳道内镜逆行乳突切除术以进入鼓室上隐窝和窦腔的病变。
使用 UBC 进行最小的鼓窦切开术，仅切除必要的骨组织以可视化病变。在 14 例中有 13 例在清晰的内镜可视化下完全清除了窦腔黏膜上的胆脂瘤。胆脂瘤清除后，使用取自耳轮的软骨重建耳道壁。该手术可更好地保留乳突。
经耳道内镜入路使用 UBC 进入窦腔的方法具有侵袭性小、功能更强的优点。UBC 在单个手柄中同时包含抽吸和冲洗系统，是一种合适的切割工具，扩大了 TEES 的适应证。
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