Novel Application of an Ultrasonic Bone Aspirator for Endoscopic Modified Medial Maxillectomy.

Background: Endoscopic modified medial maxillectomy (EMMM) is a surgical technique developed to approach maxillary sinus lesions, such as papilloma and postoperative maxillary cyst, while preserving the postoperative nasal morphology and nasal function. In this technique, a diamond burr is used to remove the bone, which may damage adjacent soft tissue. We developed EMMM using an ultrasonic bone aspirator (UBA) instead of a conventional diamond burr. The purpose of this study was to clarify the effectiveness of the UBA in EMMM in comparison to the conventional diamond burr technique in terms of operative time, intraoperative complications, postoperative symptoms, and recurrence. Methods: The medical records of all patients who underwent EMMM at Toyama University Hospital between June 2014 and December 2021 were reviewed. Patients who met the inclusion criteria were separated into Group 1, in which the UBA was used for EMMM, and Group 2, in which a drill with a diamond burr was used. Data on patient demographics, operation time, frequency of intraoperative complications and postoperative symptoms, and recurrence were statistically compared between the two groups. Results: There were no significant differences between the two groups in the patient demographic data, operative time, postoperative symptoms, or frequency of recurrence. The frequency of intraoperative damage to adjacent soft tissues was significantly lower in patients who underwent EMMM with the UBA in comparison to those who underwent EMMM with a conventional diamond burr. Conclusion: The application of the UBA to EMMM can improve surgical safety and facilitate surgical procedures.

Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator.

BACKGROUND: In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR). OBJECTIVES: The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction. MATERIALS AND METHODS: One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr. RESULTS: Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used. CONCLUSIONS AND SIGNIFICANCE: The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

Endoscopic Inside-Out Mastoidectomy with the Ultrasonic Bone Aspirator.

We report our experience using the ultrasonic bone aspirator (UBA) for transcanal endoscopic "inside out" mastoidectomy. The UBA has irrigation, suction, and nonrotatory ultrasonic bone-removing technology in 1 handpiece, which makes it appropriate for bone removal during this procedure. The results of our study show that this technique is safe and effective for patients with cholesteatoma in a small sclerotic mastoid. We also discuss the nuances associated with using the UBA during endoscopic ear surgery.

Ultrasonic bone aspirator use in endoscopic ear surgery: feasibility and safety assessed using cadaveric temporal bones.

OBJECTIVES: To describe the feasibility and assess the safety of using an ultrasonic bone aspirator in endoscopic ear surgery. METHODS: Five temporal bones were dissected via endoscopic ear surgery using a Sonopet ultrasonic bone aspirator. Atticoantrostomy was undertaken. Another four bones were dissected using routine endoscopic equipment and standard bone curettes in a similar manner. Feasibility and safety were assessed in terms of: dissection time, atticoantrostomy adequacy, tympanomeatal flap damage, chorda tympani nerve injury, ossicular injury, ossicular chain disruption, facial nerve exposure and dural injury. RESULTS: The time taken to perform atticoantrostomy was significantly less with the use of the ultrasonic bone aspirator as compared to conventional bone curettes. CONCLUSION: The ultrasonic bone aspirator is a feasible option in endoscopic ear surgery. It enables easy bone removal, with no additional complications and greater efficacy than traditional bone curettes. It should be a part of the armamentarium for transcanal endoscopic ear surgery.

Feasibility of the Ultrasonic Bone Aspirator in Retrosigmoid Vestibular Schwannoma Removal.

OBJECTIVE: Postoperative headache is an undesirable consequence of retrosigmoid vestibular schwannoma (VS) removal. An ultrasonic bone aspirator (UBA) may reduce headache by minimizing subarachnoid bone dust dispersion. The feasibility of removing internal auditory canal (IAC) bone with a UBA is unknown. This study assessed volume and duration of IAC bone removal in clinical and laboratory settings. STUDY DESIGN: (1) Retrospective review of radiologic data and intraoperative videos. (2) Cadaveric temporal bone model. SETTING: (1) Tertiary care medical center. (2) Laboratory. SUBJECTS METHODS: We calculated the volume of IAC bone drilled during retrosigmoid VS removal using postoperative computed tomography scans. We then measured the time spent actively drilling IAC bone by analyzing operative videos. Finally, we measured bone ablation rates in a cadaveric temporal bone model using a drill and UBA. RESULTS: The mean ± SD volume of IAC bone removed during surgery was 0.32 ± 0.17 mL (n = 9). The time spent actively removing IAC bone with a drill was only 10.4 ± 3.5 minutes, less than a third of the total IAC opening time of 34.2 ± 13.1 minutes (n = 5). On cadaveric specimens, the UBA removed bone at 0.21 ± 0.03 or 0.35 ± 0.07 µL/s at 15% or 50% power, respectively (n = 4). This extrapolates to 15.0 ± 3.0 to 25.0 ± 3.9 minutes to remove the same 0.32 mL from surgery. CONCLUSIONS: The volume and duration of IAC bone removal during retrosigmoid VS surgery are small. Using a UBA at low power instead of a drill would extend the length of surgery by 5 to 15 minutes, with the theoretical potential for reducing headache.

Reduction of bone dust with ultrasonic bone aspiration: implications for retrosigmoid vestibular schwannoma removal.

OBJECTIVE: Postoperative headache is not uncommon after retrosigmoid vestibular schwannoma removal. Bone dust dispersed into the subarachnoid space during drilling may be responsible. If dispersion could be reduced, headache incidence might be decreased. An ultrasonic bone aspirator (UBA) containing an integrated suction at the tip may more effectively suction bone dust created during bone removal. The objective is to determine whether a UBA results in less bone dust dispersion than a standard otologic drill. STUDY DESIGN: Cadaveric temporal bone quantitative model. SETTING: Laboratory. SUBJECTS AND METHODS: Temporal bone blocks were placed in a watertight enclosure. Under irrigation, bone was removed by use of either a drill or a UBA. The settings of the UBA were varied. The irrigant containing bone dust was microfiltered, and bone dust was weighed. Differences were compared across groups (n = 2-9 per group). Ablation times were also recorded (n = 3 per group). RESULTS: Only 3% (SD = 1.6%, n = 7) of the drilled bone mass was re-collected as bone dust with the UBA under optimized settings (power = 15%, suction = 100%, irrigation = 15 mL/min) compared with 81% (SD = 10%, n = 4) with the drill and external suction (P < .001). Increasing UBA power and reducing suction led to significantly more bone dust dispersal than with optimized settings. Varying irrigation did not have a significant effect. Bone ablation time was 1.4 times longer with the UBA at 50% power compared with the drill at maximum power. CONCLUSIONS: The UBA resulted in approximately 25 times less bone dust dispersion than the otologic drill at optimized settings.

Endoscopic Dacryocystorhinostomy Using Ultrasonic Bone Aspirator

PURPOSE: To report the results of 15 endoscopic dacryocystorhinostomy (eDCR) cases using ultrasonic bone aspirator (UBA) and evaluate the UBA efficiency in these surgeries. METHODS: Fifteen eyes of 12 patients presenting with nasolacrimal duct obstruction were evaluated in the present study. eDCR and osteotomy were performed using UBA (Cusa excel, Integra, New Jersey, NJ, USA) from January 2014 to June 2014. RESULTS: All the patients showed complete resolution of the epiphora. There were no complications or recurrences for a minimum of 10 months postoperatively. CONCLUSIONS: This is the first report on eDCR using UBA. The surgeries were successful and no complications were observed. eDCR using UBA is an easy, safe and effective technique with minimal heat production, minimal damage to the surrounding soft tissue and quick and precise bone removal.

Endoscopic ultrasonic dacryocystorhinostomy for recurrent dacryocystitis following rhinoplasty.

UNLABELLED: The lacrimal sac is the structure most vulnerable to injury when performing rhinoplastic osteotomies. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies can potentially tear the medial canthal tendon and injure the underlying lacrimal sac, possibly resulting in dacryocystitis. In this case report, the authors discuss a case of dacryocystitis following primary rhinoplasty; this injury was repaired with endoscopic dacryocystorhinostomy (DCR) using a Sonopet ultrasonic bone aspirator (Stryker, Kalamazoo, Michigan) at a single institution. This method achieved nasolacrimal duct patency, and the patient continued to be symptom-free at an 18-month follow-up. This is the first reported case of recurrent dacryocystitis following rhinoplasty as treated by endoscopic DCR. LEVEL OF EVIDENCE: 5.

Application of Ultrasonic Bone Aspirator in Transnasal Endoscopic Dacryocystorhinostomy : A Case Report

Transnasal endoscopic dacryocystorhinostomy (eDCR) has been performed with relative ubiquity since the introduction of the rigid nasal endoscope, with multiple reports found in the literature. Multiple techniques have been used for lacrimal osteotomy, including standard rongeurs, laser, radiofrequency and microdrill. The ultrasonic bone aspirator (UBA) has been described for a variety of neurosurgical procedures and was initially studied in orbital and lacrimal surgery by Sivak-Callcott et al. We report a 74-year-old female patient who suffered from epiphora and pus-like discharge of the right eye. The bone of the lacrimal sac fossa was thinned and removed using an ultrasonic bone aspirator. The patient had a significant symptom improvement without any complications related to UBA use. We applied an ultrasonic bone aspirator for a patient with lacrimal duct stenosis and report a successful result.

Comparing use of the Sonopet(®) ultrasonic bone aspirator to traditional instrumentation during the endoscopic transsphenoidal approach in pituitary tumor resection.

BACKGROUND: The Sonopet(®) ultrasonic bone aspirator (Stryker(®) , Kalamazoo, MI) has been used within neurosurgery, otolaryngology and in other fields, but to our knowledge has not been reported in the literature for use in endoscopic transsphenoidal approaches (TSAs) to the skull base. The study objective was to compare use of the ultrasonic bone aspirator (UBA) vs traditional cold steel instrumentation during TSA in terms of operative time and blood loss. METHODS: The study design was a prospective, randomized, single-blinded controlled clinical trial. The population included patients who presented to a tertiary care skull base center with pituitary tumors amenable to endoscopic resection. Participants were randomized to either an endoscopic approach using the ultrasonic bone aspirator (n = 66) or traditional steel instrumentation (n = 64). Outcomes measured were operative time and blood loss for the approach and exposure portion of the procedure. RESULTS: The use of the UBA resulted in a significant reduction in both operative time (31.92 ± 3.04 minutes vs 41.32 ± 2.75 minutes, p < 0.0001) and blood loss (16.5 ± 5.37 milliliters vs 22.57 ± 3.09 milliliters, p < 0.0001) compared to traditional steel instrumentation. CONCLUSION: This study is, to our knowledge, the first prospective, randomized, controlled clinical trial comparatively demonstrating the speed, safety and efficacy of the ultrasonic bone aspirator for endoscopic TSA to the skull base. Although the UBA offers surgical benefits, the cost of disposables may limit its usefulness to use in tertiary care institutions where operative cost can be shared across departments and with the hospital.