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Application of Water-jet Technology in Nasolacrimal-duct Surgery using a High-resolution Endoscope Initial Experience
Knorrn M., Bleifuß R., Ehrich D., Struck H. G., Wilhelm F.,
Martin-Luther-Universität, Klinik und Poliklinik für Augenheilkunde (Halle/Saale)
Background: In nasolacrimal duct surgery the erbium-YAG laser is increasingly used in conjunction with endoscopic microdrill devices. This way bloodless and non-touch endoscopic operations are possible. Because the water-jet is already established in several surgical specialties it was logical to test it as alternative for treating stenotic lacrimal ducts and dacryoliths.
Methods: The experiments were performed on the nasolacrimal tubes of dead rabbits. Before surgery the nasolacrimal duct anatomy of rabbits was thoroughly studied. Animal dacryoscintigraphies of the animals were performed, too. The water-jet tube was connected to a flexible dacryoendoscope that contained both video endoscopic fibres and fibres for illumination. Different water pressures were tested.. Fibrin adhesive was used in order to simulate obstructed lacrimal ducts.
Results: The video demonstration shows clearly that a water jet is sufficient for re-canalization of the lacrimal drainage system. Additionally, the steady water stream ensures good visualization of the illuminated operation area. However, first tissue damage occurs with pressures beyond 25 bar.
Conclusions: The initial animal experiments were very promising. However, further experiments are necessary in order to determine different essential operation parameters such as optimal water pressure, minimum nozzle diameter of the tip and best water stream velocity in lacrimal duct surgery.