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Published on: June 20, 2018
Comparing the reverse Trendelenburg and horizontal position for endoscopic sinus surgery: a randomized controlled
Iain F Hathorn1, Al-Rahim R Habib, Jamil Manji
1Division of Otolaryngology, University of British Columbia, St Paul's Sinus Centre, Vancouver, British Columbia, Canada. iainhathorn@hotmail.com
Summary
The 15-degree reverse Trendelenburg position (RTP) significantly improves endoscopic visualization and reduces blood loss during functional endoscopic sinus surgery (FESS). This position is recommended for FESS procedures to enhance surgical outcomes.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Functional endoscopic sinus surgery (FESS) is a common procedure for chronic rhinosinusitis.
- Optimizing the surgical field and minimizing blood loss are critical for successful FESS outcomes.
- The impact of patient positioning on surgical field visualization and intraoperative bleeding in FESS requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of the 15-degree reverse Trendelenburg position (RTP) compared to the horizontal position (HP) in improving endoscopic field of view during FESS.
- To assess the effect of RTP on reducing intraoperative blood loss in patients undergoing FESS.
Main Methods:
- A prospective, randomized controlled trial was conducted with 64 patients diagnosed with chronic rhinosinusitis undergoing FESS.
- Patients were randomized to either the 15-degree RTP or the horizontal position (HP).
- The primary outcome measure was the Boezaart endoscopic field-of-view grading system, with secondary measures including blood loss, CT scores, and surgical parameters.
Main Results:
- The 15-degree RTP group demonstrated a significantly better endoscopic field of view compared to the HP group (mean Boezaart score: 1.66 vs 2.33, P < .001).
- Intraoperative blood loss, both total and per minute, was significantly lower in the RTP group (P = .01 and P = .03, respectively).
- No significant differences were observed in disease severity, surgery duration, or mean arterial pressure between the two positions.
Conclusions:
- The 15-degree reverse Trendelenburg position is an effective method for enhancing endoscopic visualization during FESS.
- Utilizing the 15-degree RTP can lead to a reduction in intraoperative blood loss in FESS procedures.
- The study recommends the adoption of the 15-degree RTP for functional endoscopic sinus surgery to improve surgical outcomes.
