Paranasal Sinus Visualization Capabilities of a Novel Articulating Rigid-Flexible Endoscope: A Cadaveric Study

Rigid endoscopes have allowed surgeons to safely perform endoscopic sinus surgery. However, their rigid nature creates inherent visualization limitations. The study herein looks to assess the visualization potential of a novel articulating rigid-flexible endoscope when compared with traditional rigid and flexible nasal endoscopes.

A new articulating endoscope capable of bending its distal tip and extending beyond the point of angulation was compared with 0- and 30-degree 4.0-mm rigid endoscopes, and a 3.7-mm flexible nasopharyngoscope in their ability to visualize predefined anatomic landmarks within the maxillary, sphenoid, and frontal sinuses. Visible markers were placed at applicable landmarks using image guidance in a total of five cadaveric heads. The ability to visualize these intrasinus anatomic landmarks was recorded for each scope.

When inspecting the surgically naive anatomy of all sinus ostia and predefined anatomic landmarks, the articulating endoscope had superior visualization ( p  < 0.01) compared with the 0-degree, 30-degree, and flexible endoscopes throughout all sinuses (maxillary sinus: 62.5, 0, 5, and 0%, respectively; sphenoidal sinus: 92.5, 27.5, 37.5, and 40%, respectively; frontal sinus: 51.4, 5.7, 20, and 37.1%, respectively). After performing a Draf IIa, the articulating endoscope was able to visualize 100% of the predefined frontal sinus landmarks compared with 22.9, 45.7, and 65.7% for the 0-degree, 30-degree, and flexible endoscopes, respectively ( p  < 0.001).

The articulating rigid-flexible endoscope is superior in reaching and visualizing anatomic landmarks within the paranasal sinuses, compared with standard endoscopes.