In-Office Sinus Surgery Without General Anesthesia

There has been tremendous advances in sinus surgery over the past decade. From the elimination of nasal packing after most routine sinus surgery to the more recent use of balloons to open the sinus cavities, patient comfort has improved greatly after this particular operation. What used to be a several week recovery may now only be a few days.

Balloon sinuplasty in particular has been revolutionary in the surgical treatment of chronic sinusitis. Though sinus surgery normally is performed under general anesthesia, balloon sinuplasty now allows this operation to be performed awake WITHOUT sedation using local anesthesia only.

At its essence, sinus surgery "opens" up blocked sinus cavities to allow drainage and ventilation. Traditional sinus surgery "removes" tissue to accomplish this goal whereas balloon sinuplasty stretches open the sinus cavity without the need for tissue removal.

Given the lack of tissue removal with balloon sinuplasty, there is less pain and faster recovery after the procedure.

What are the steps?

After adequate anesthesia of the nose using both topical and injectable numbing medicine... Step 1 Under endoscopic guidance, the balloon catheter is introduced into the nasal cavity and guided towards the target sinus cavity opening. Depending on the system used, a sinus guidewire or sinus illumination may be used to help with the guidance.
Step 2 Once the sinus balloon catheter is correctly positioned across the blocked sinus opening, the balloon is gradually inflated to stretch open the ostia.
Step 3 After several seconds, the sinus balloon catheter is then deflated and removed leaving an enlarged sinus opening allowing for the return of sinus drainage. There is little to no disruption to mucosal lining.

Of course, not all patients are candidates for balloon sinuplasty, let alone this procedure to be done awake with local anesthesia alone.

In particular, balloon sinuplasty can only address blockages involving the frontal, maxillary, and sphenoid sinus cavities. Ethmoid sinus cavities can NOT be corrected using this method.

Also, balloon sinuplasty does not allow for tissue biopsies (by definition, the advantage of balloon sinuplasty is the lack of need to remove any sinus or nasal tissues). As such, if there are any masses present including nasal polyps, traditional sinus surgery is the better way to go.

Surgery Without Wires

Surgery is messy... and I don't mean in terms of blood and guts...

What I mean are wires, cables, tubing, etc.

Let's take a routine tonsillectomy and adenoidectomy for example...

1. Electric cord for the operating table


2. Electric cord for the anesthesia machine


3. Electric cord for the surgeon's headlight


4. Light cord from the surgeon's headlight to the lightbox


5. Breathing circuit tube from the patient to the anesthesia machine


6. Carbon dioxide outflow tube from the patient to the anesthesia machine


7. Suction tubing from the surgical table to the vacuum canister


8. Vacuum cable from the vacuum canister to the wall socket


9. Electrocautery cable (along with electric cord to power the machine)


10. Coblation cable (along with electric cord to power the machine)


11. IV fluids lines from patient to IV bags


12. EKG lines


13. Grounding pad cable


14. All the wires and cables that go with running a computer


15. etc etc etc

It's an "organized" chaos of cords, tubes, electric wires, etc all emanating away from the patient like a Man-of-Wars jellyfish.

Pictures shown on the internet as well as movies are "staged" and appear to be neat and orderly, but believe me (as someone who has had pictures taken), surgeons and nurses take the time to "tidy" things up before the picture or video is recorded giving a false impression of neatness.

99% of the time, everyone knows where everything is, so it's not a problem. However, when an unanticipated emergency happens, things get confusing and in fact dangerous to not only the patient, but the staff (I recall one incidence of a nurse running to get a surgical tray, tripping on one of the numerous cords mentioned above, falling, and breaking her hand).

When something stops working... we literally have to trace the cord from source to origin to figure out why something stopped working. With all the cords present, this tracing needs to be done by hand and eye (analogous to an entertainment system with all the wires in the back, one would trace out the cords by hand and eye).

IS there a better way???

Of course the operating room staff takes the time to bundle and organize the various cords, but the fact remains that the cords are there.

What about wireless technology to power instruments or relay information?

Well, NPR reported on August 23, a young 22 year-old entrepreneur Meredith Perry, who has invented and patented a way to transmit power over the air without the need for wires using ultrasound. Yup... the same ultrasound used to look at a human fetus in the womb.

Her ingenious idea is to use ultrasound to "vibrate" the air which than vibrates a piezoelectric transducer contained within nearby devices. The vibration of the piezoelectric transducer will than generate an electric current which can be stored in a battery and used to power anything that requires energy.

I acknowledge that it may take time before such wireless power is available to power large surgical devices, but one can always hope!

Read the NPR story here.

New Video on Endoscopic Vocal Cord Mass Injection & Bronchoscopy Without Sedation

We have produced a new video demonstrating how vocal cord masses can be injected with medications (like steroids) under endoscopic guidance without the need for any sedation. This video also includes bronchoscopy that was performed at the same time (also without any sedation).

Check out the video here!