Preliminary Report of Full-Endoscopic Spinal Dural Repair Using Double-Arm Sutures With a Biportal Endoscopic System:...

Full-endoscopic spine surgery (FESS) offers a minimally invasive approach with significant advantages, but dural tears, occurring in 2.7% of cases, remain a significant challenge. Nerve rootlet herniation through these defects often requires conversion to open surgery, compromising the benefits of FESS. A newly commercialized dural repair device, DuraStat, facilitates suture needle passage through the dura, presenting an opportunity to evolve the well-established inside-out suture repair techniques from minimally invasive tubular surgery to full-endoscopic procedures. The aim of this study was to validate a biportal full-endoscopic dural repair technique using the DuraStat double-arm suture in an ex Vivo animal model.

FESS was conducted on fresh porcine cadaveric spines at the L6/S1 segment. A dural defect was meticulously created using endoscopic instruments to simulate intraoperative durotomy with accompanying nerve rootlet herniation. The DuraStat double-arm suture was used in an inside-out technique to achieve approximation of the dural defect. Closure was completed utilizing an extracorporeal knotting technique, with the knot advanced and secured via a knot pusher. Repair times for 2 surgeons were recorded over 5 trials to evaluate the learning curve, assessing the feasibility and efficiency of this repair technique.

All repair procedures were completed successfully without complications. The mean repair time decreased significantly, with an approximate 76.5% reduction from trial 1 (mean: 40.5 minutes) to trial 5 (mean: 9.5 minutes). By the fifth trial, repair time was consistently reduced to less than 10 minutes, demonstrating substantial improvements in efficiency and proficiency with repeated practice.

A full-endoscopic suture repair was performed using the inside-out method with the DuraStat double-arm suture under a biportal endoscopic system on the ex Vivo iatrogenic durotomy porcine animal model. The technique was successfully executed with the repair time reduced to less than 10 minutes after a learning curve of 5 trials.