Endoscopic sinus surgery: advantages of the bimanual technique

The orthodox endoscopic sinus surgical technique is "one-handed," which means that the surgeon holds the endoscope in one hand and uses the free hand for other instruments or suction. This technique has its limitations. When there is a lot of bleeding or when tension needs to be kept on tissue so that it can be cut cleanly, this is best done using both hands. This "bimanual" technique was described > 10 years ago, and although it offers several advantages, it is rarely used. The main reason is the requirement for two trained endoscopists. In a prospective randomized interventional study, the duration of the operation using the one-handed technique as opposed to the bimanual technique was compared.

Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis were evaluated. One side of the nose underwent the conventional one-handed technique, while the other side had the bimanual technique. The operation time for each side was noted.

Fifty patients (31 men and 19 women) with a mean age of 47.6 years (22-80 years) were evaluated. The mean operation time with the one-handed technique was 39.3 minutes (9-93 minutes). With the bimanual technique, the mean operation time was 31.0 minutes (6-78 minutes). The reduction in operation time with the bimanual technique was 21% and was highly significant (p < 0.001).

The bimanual endoscopic sinus surgery technique leads to a significant reduction in operation time. The patient may benefit from a shorter operation time and the surgeon has better visibility that may reduce the incidence of complications. Furthermore, there are potential economic advantages because of the increased efficiency of surgical time.