Piezo-assisted external dacryocystorhinostomy versus conventional external dacryocystorhinostomy

Aim The aim was to evaluate the role of piezoelectric technique in external dacryocystorhinostomy (DCR) compared with conventional external DCR regarding surgical time, efficacy, safety, and cost. Patients and methods A prospective randomized, comparative interventional study was performed at Al-Azhar University Hospitals, Cairo, between October 2017 and August 2020. A total of 40 eyes of 38 patients who underwent primary external DCR were classified into two groups: group A included 20 eyes that underwent conventional external DCR, and group B included 20 eyes that underwent piezo-assisted external DCR. Patients of both groups received bicanalicular intubation with silicon tube. Surgical outcome was evaluated. Results There was a statistically highly significant increase in the time and the size of osteotomy in group A than that in group B, with P values of less than 0.001 and less than 0.001, respectively. There was a statistically highly significant difference between the two groups regarding the shape of osteotomy, with P value less than 0.001. However, there were statistically insignificant differences between the two groups regarding the amount of bleeding in ml, and injury to nasal mucosa, with P values of 0.202 and 1.000, respectively. Moreover, there were statistically highly significant increases in visibility of scar in group B than that in group A at 1 week and at 6 months postoperatively, with P values of less than 0.001 and 0.002, respectively. Conclusion The use of piezosurgery is a safe and effective tool for external DCR, offering comparable outcomes to more commonly used traditional rongeurs. By reducing damage to adjacent tissue such as nasal mucosa owing to its selective bone cutting properties, this device is an appealing option for the surgeons and to reduce surgeon fatigue. On the contrary, the use of a Kerrison rongeur is associated with lower cost and possibly quicker time.