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Sinus Laser-Assisted Closure Under Tumescent Local Anesthesia for Pilonidal Disease: A Pilot Study
Gabriela K Pomper1,2, Antun Previsic2, Antonija Vrbanic Sutalo3
1Faculty of Dental Medicine and Health, University of Osijek, Osijek, HRV.
Objectives:
Sinus laser-assisted closure (SiLaC) is a minimally invasive option for management of pilonidal sinus disease (PSD). Tumescent local anesthesia (TLA) may further facilitate outpatient treatment; however, its use in this setting has not been adequately studied. This pilot study aimed to assess the feasibility of SiLaC performed under TLA.
Materials And Methods:
Between September 2025 and January 2026, 22 consecutive patients with PSD underwent SiLaC under TLA. Demographic characteristics, operative time, total volume of tumescent solution, and calculated lidocaine dose were recorded. Pain was assessed preoperatively, intraoperatively, and on postoperative days 1, 2, 3, and 7 using the Visual Analog Scale (VAS; 0-10). Postoperative complications and outpatient follow-up visits were documented, and early recurrence was assessed at 90 days within a predefined follow-up window of 90 ± 7 days.
Results:
The median age was 23 years (range, 18-62 years), and 19 of 22 patients were male. Median operative time was 30 minutes (range, 25-45 minutes), and median tumescent volume was 160 mL (range, 80-280 mL). Median VAS scores were 1 preoperatively (range, 1-2), 2 intraoperatively (range, 1-3), 3 on postoperative day 1 (range, 1-6), 2.5 on day 2 (range, 1-5), 2 on day 3 (range, 1-7), and 1 on day 7 (range, 1-2). Three minor postoperative events occurred: two cases of localized painful swelling and one case of minor bleeding. No anesthesia-related or major complications were observed. All 22 patients completed the 90-day follow-up; no patients were lost to follow-up, and no recurrences, wound healing disorders, or delayed complications were observed in the full evaluable cohort (0/22).
Conclusion:
SiLaC performed under TLA appears feasible, well tolerated, and safe for appropriately selected patients in an outpatient setting. Given the small sample size, absence of a control group, and limited follow-up, larger prospective comparative studies with longer follow-up are needed to validate these findings and to determine whether TLA offers advantages over conventional local infiltration anesthesia, particularly in more extensive disease.