Paranasal Sinus Visualization Capabilities of a Novel Articulating Rigid-Flexible Endoscope: A Cadaveric Study.

Introduction: Rigid endoscopes have allowed surgeons to safely perform endoscopic sinus surgery. However, their rigid nature creates inherent visualization limitations. The study herein looks to assess the visualization potential of a novel articulating rigid-flexible endoscope when compared with traditional rigid and flexible nasal endoscopes.

Methods: A new articulating endoscope capable of bending its distal tip and extending beyond the point of angulation was compared with 0- and 30-degree 4.0-mm rigid endoscopes, and a 3.7-mm flexible nasopharyngoscope in their ability to visualize predefined anatomic landmarks within the maxillary, sphenoid, and frontal sinuses. Visible markers were placed at applicable landmarks using image guidance in a total of five cadaveric heads. The ability to visualize these intrasinus anatomic landmarks was recorded for each scope.

Results: When inspecting the surgically naive anatomy of all sinus ostia and predefined anatomic landmarks, the articulating endoscope had superior visualization ( p  < 0.01) compared with the 0-degree, 30-degree, and flexible endoscopes throughout all sinuses (maxillary sinus: 62.5, 0, 5, and 0%, respectively; sphenoidal sinus: 92.5, 27.5, 37.5, and 40%, respectively; frontal sinus: 51.4, 5.7, 20, and 37.1%, respectively). After performing a Draf IIa, the articulating endoscope was able to visualize 100% of the predefined frontal sinus landmarks compared with 22.9, 45.7, and 65.7% for the 0-degree, 30-degree, and flexible endoscopes, respectively ( p  < 0.001).

Conclusion: The articulating rigid-flexible endoscope is superior in reaching and visualizing anatomic landmarks within the paranasal sinuses, compared with standard endoscopes.