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Surgical Instrumentation, Setup, and Patient Positioning

A. Surgical Instrumentation (Figures 3 and 4)

Very few instruments are actually required to perform ESS. However, as one gains more surgical experience, there may be a need for additional instrumentation depending on the type of procedure or on the surgeon's personal preferences. The minimum instrumentation required for most of the dissections in this manual include: 1) a 30-degree telescope, 2) a 360-degree backbiting forceps, 3) a 360-degree sphenoid punch or forceps, 4) a 4-mm-long curved suction, 5) a 10 or 12 French straight (Frazier) suction with calibrated centimeter markings, 6) a 3.5-mm straight through-cut forceps, 7) a 3.5-mm upbiting through-cut forceps, 8) a small angled ball probe, and 9) a Cottle periosteal elevator. Powered instrumentation with a 4-mm straight and/or 60-degree cannula can be used in lieu of forceps to perform an ethmoidectomy and multiple sinusotomies.

For more advanced procedures, a 70-degree telescope is useful to visualize lateral or superior recesses of the frontal, maxillary, or sphenoid sinus. Curettes of various sizes are useful for removing thick bone, especially around the frontal ostium or sphenoid rostrum. Powered instrumentation with cutting or diamond burrs may also be necessary to carefully remove bone around critical structures such as the lacrimal sac, skull base, optic nerve, or carotid artery.

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