A Protected Microknife System for Safe and Ergonomic Dural Incision in Endoscopic Endonasal Surgery: A Technical Note

The endoscopic endonasal approach (EEA) has undergone substantial evolution over the past 3nulldecades, largely driven by advances in visualization and the development of specialized instrumentation. Despite this technological progress, the long-term availability and ergonomics of dedicated tools remain limiting factors. In particular, safe dural incision within the confined nasal corridor continues to depend on instruments that are often difficult to maintain or replace.

To describe a simple, reproducible technical modification aimed at improving safety, ergonomics, and sustainability during the dural incision phase of the EEA.

A disposable microknife was mounted on a reusable straight titanium handle and covered with a standard suction catheter trimmed to the appropriate length, functioning as a partially retractable protective sheath. The technique was applied in 30 consecutive endonasal procedures for sellar and suprasellar lesions.

The modified instrument was seamlessly integrated into the standard four-hand surgical workflow. It enabled safe introduction, controlled blade exposure, and secure withdrawal under continuous endoscopic visualization. The protective sheath effectively minimized inadvertent mucosal trauma during insertion and removal, while preserving tactile feedback and maneuverability. No additional setup time was required. Surgeons reported improved control and reduced cognitive workload, particularly in narrow or fibrotic corridors.

This technical adaptation represents a safe, ergonomic, and cost-effective refinement of the dural incision step in endoscopic endonasal surgery. Beyond its immediate practical advantages, it exemplifies incremental, experience-driven innovation in skull base surgery, consistent with the "Idea-Development" stage of the IDEAL framework.