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Updated: Jun 11, 2026
Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis
Published on: February 24, 2023
Epinephrine-added Irrigation Shortens and Stabilizes Operative Time in Full-endoscopic Lumbar Decompression after
Shota Takenaka1, Sadaaki Kanayama, Shutaro Yamada
1Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan.
Epinephrine-added irrigation significantly improved visualization and reduced bleeding during uniportal full-endoscopic unilateral laminotomy for bilateral decompression (FESS-ULBD). This technique led to shorter, more consistent operative times without adverse hemodynamic effects, even after accounting for the learning curve.
Area of Science:
- Minimally Invasive Spine Surgery
- Endoscopic Spinal Decompression
- Surgical Visualization Techniques
Background:
- Maintaining a clear operative field is challenging in full-endoscopic lumbar decompression.
- Epinephrine-added irrigation enhances visualization in arthroscopy, but its role in endoscopic spine surgery is under-investigated.
- Learning curve effects can confound the assessment of new surgical techniques.
Purpose of the Study:
- To evaluate the impact of epinephrine-added irrigation on operative efficiency and visualization during uniportal full-endoscopic unilateral laminotomy for bilateral decompression (FESS-ULBD).
- To adjust for learning curve effects in the assessment of epinephrine-added irrigation during FESS-ULBD.
- To determine if epinephrine-added irrigation impacts hemostasis and operative time in FESS-ULBD.
Main Methods:
- Retrospective observational study of 50 FESS-ULBD cases.
- Comparison of saline-only irrigation (SAL) versus epinephrine-added irrigation (EPI).
- Segmented regression interrupted time series (ITS) analysis to adjust for learning curve, evaluate operative time, visibility, and hemostasis.
Main Results:
- Epinephrine-added irrigation (EPI) significantly reduced mean operative time (99.3 min in SAL vs. 60.7 min in EPI).
- ITS analysis showed immediate operative time reduction (-18.3 min) and decreased variability with EPI.
- Visibility improved (44.4% "Good" in SAL vs. 100% in EPI), and the need for hemostasis decreased (P=0.032).
- No significant difference in intraoperative hypertension events or need for antihypertensive medication was observed.
Conclusions:
- Epinephrine-added irrigation improves visualization and reduces hemostasis burden during FESS-ULBD.
- This technique leads to shorter and more consistent operative times.
- Epinephrine-added irrigation is safe, with no increased hemodynamic instability or postoperative bleeding under routine monitoring, after adjusting for learning curve effects.
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