alexa Controlling the surgical field during a large endoscopic vascular injury.


Otolaryngology: Open Access

Author(s): Valentine R, Wormald PJ

Abstract Share this page

Abstract OBJECTIVES: Since the advent of endonasal skull base surgery, internal carotid artery (ICA) injury has been considered the most dramatic and challenging intraoperative complication. A large vascular injury creates an immediately challenging surgical scenario with rapid blood loss that may result in exsanguination of the patient. Recently we have developed an animal model of the endoscopic, endonasal vascular injury. We describe important surgical steps required in managing the surgical field during a catastrophic vascular event. METHODS: A total of 42 endoscopic carotid artery injuries and 25 endoscopic venous injuries were performed. Throughout the injuries, the "two-surgeon" technique was used to achieve surgical field control. Videoendoscopy was performed throughout the implementation of these surgical techniques. RESULTS: Techniques found useful in controlling the surgical field included the two-surgeon technique, careful selection of the most appropriate nostril for endoscope positioning, large bore suction placement, suction guidance of the vascular stream through the contralateral nostril, and avoidance of suction obstruction. Only once the surgical field could be controlled can the injury site be addressed. CONCLUSIONS: Controlling the endoscopic endonasal surgical field during vascular injuries relies on the cooperation of the surgical team and a step-based approach including careful endoscopic maneuvering within the nasal corridor, and appropriate suction selection and positioning with respect to the endoscope. Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc. This article was published in Laryngoscope and referenced in Otolaryngology: Open Access

Relevant Expert PPTs

Relevant Speaker PPTs

Recommended Conferences

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version