The quantification of surgical flow disruptions secondary to fogging and biofouling of endoscopic lens during endoscopic skull base surgeries.

PURPOSE: Despite significant progress in field of endoscopy, lens contamination (LC) continues to plague endoscopic surgeries. Apart from being an ergonomic nuisance, it potentially contributes to adverse surgical outcomes. The literature on the problem of LC during endoscopic skullbase surgeries (ESBSs) is lacking. The current study was conducted to address this lacuna.

METHODS

In this study, operative videos of ESBSs performed by the author were retrospectively analysed. The videos were edited on Apple iMovie to identify surgical flow disruptions (SFDs) due to LC. The total number and duration of SFDs were then calculated to determine proportion of total surgical time spent on lens cleaning.

RESULTS

Ten operative videos of ESBSs were analysed. The average duration of surgeries was 204 min. The various pathologies included were pituitary macroadenomas (n = 6), craniopharyngiomas (n = 2) and clival chordomas (n = 2). The average number and duration of SFDs were 56 (range: 43-68) and 15.5 min (range: 150-245 min) per surgery, respectively. The average rate of SFDs was 16 events per hour. Thus, 7.5 % of surgical time was wasted due to LC. Intracavitary cleaning was done in 73 % and extracavitary in 27 % of SFDs. On an average, endoscope had to be removed out of nasal cavity 15 times per surgery for cleaning, which means scope being removed q13.6 min.

CONCLUSIONS

The current study is first of its kind in literature that addresses the issue of LC in ESBSs. It shows that LC is a significant cause of SFDs during ESBSs. The study also reveals that probably SFDs due to LC are more frequent in ESBSs than laparoscopic surgeries. However, more studies on LC in ESBSs are needed to corroborate the findings of this study.