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Managing water dynamics for optimal outcomes in unilateral biportal endoscopic surgery: preliminary results in a new
Qian-Liang Wang1, Jian-Peng Chen1, Yu-Jian Peng1
1Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, Jiangsu, 215004, China.
Background:
In recent years, unilateral biportal endoscopic (UBE) surgery has become one of the most popular minimally invasive spine surgeries. Unlike traditional open surgery, UBE surgery is performed in isotonic saline solution. Therefore, comprehending the water dynamics involved in UBE surgery is crucial.
Methods:
This prospective study involved 29 patients with single-level lumbar instability or degenerative disk disease who underwent UBE surgery between April 2021 and March 2022. Water flow pressure was measured using a disposable pressure transducer. Multifidus muscle MRI images were analyzed by ImageJ software at intervertebral disc levels. Perioperative blood loss was estimated by the Gross formula. The obtained data were then analyzed with independent t tests, chi-squared tests, and Pearson's correlation.
Results:
Height and weight were risk factors for increased water flow pressure during UBE surgery (r = 0.424, P = 0.022, r = 0.384, P = 0.040). The phenomenon of low water flow pressure led to escalations in perioperative total blood loss, hematocrit loss and hemoglobin loss (r = -0.369, P = 0.049, r = -0.424, P = 0.022, r = -0.405, P = 0.029). An excessive water flow pressure can worsen postoperative multifidus swelling and elevate the patient's leg pain visual analogue scale (VAS) score at 1 week (r = 0.442, P = 0.016, r = 0.394, P = 0.034).
Registration:
Trial registration Chinese Clinical Trial Registry, registration number ChiCTR2300078497, date of registration: 11/12/2023.
Conclusion:
Both low and high water flow pressures can have deleterious effects. The water flow pressure should be controlled within a reasonable range during UBE surgery.
