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Updated: May 22, 2026
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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
Published on: August 7, 2018
The outside-in approach to the modified endoscopic Lothrop procedure
David Chin1, Kornkiat Snidvongs, Larry Kalish
1Division of Rhinology, Skull Base Surgery, St. Vincent's Hospital, Sydney, Australia. drdavidchin@gmail.com
The Laryngoscope
|May 3, 2012
Summary
The outside-in modified endoscopic Lothrop procedure (MELP) offers a safe and efficient approach to frontal sinus surgery, especially when the frontal recess is compromised. This technique results in shorter, predictable operative times compared to the standard method.
Area of Science:
- Otolaryngology
- Neurosurgery
- Endoscopic Sinus Surgery
Background:
- The standard modified endoscopic Lothrop procedure (MELP) drilling typically starts at the frontal recess (FR).
- This standard approach presents challenges when the FR is affected by tumors, inflammation, or scarring.
- An alternative outside-in MELP approach is described, where sinusotomy limits are defined first, addressing the FR last.
Purpose of the Study:
- To describe and evaluate the outside-in modified endoscopic Lothrop procedure (MELP).
- To compare operative times and complication rates between the outside-in MELP and the standard MELP.
- To assess the feasibility and safety of the outside-in MELP approach.
Main Methods:
- A case-control study involving patients undergoing MELP for inflammatory disease or endoscopic skull base surgery.
- Data collected included demographics, disease characteristics, FR involvement, and operative times.
- Operative time was measured from intraoperative video recordings, focusing on time to frontal sinus and recess connection for outside-in MELP and Lothrop cavity completion for both groups.
- Perioperative complications were meticulously recorded.
Main Results:
- Twenty-four patients underwent the outside-in MELP, and six had the standard MELP.
- Lothrop cavity completion time was significantly shorter for the outside-in MELP (30.60 ± 14.10 minutes) compared to the standard approach (69.66 ± 64.52 minutes; P = .002).
- In the outside-in MELP group, mean time to frontal sinus floor discovery was 8.41 ± 6.29 minutes and to recess connection was 26.50 ± 12.45 minutes.
- Lothrop cavity completion was faster in tumor cases (24.63 ± 6.49 minutes) compared to chronic rhinosinusitis cases (P = .05).
- Only one patient experienced skin edema; no other significant complications were noted.
Conclusions:
- The outside-in MELP is a technically feasible and safe surgical technique.
- This approach provides wide access to the frontal sinus and allows for efficient Lothrop cavity development.
- Early definition of dissection limits in the outside-in MELP leads to robust and predictable operative times.
