External Dacryocystorhinostomy: A Comparison Of Ultrasonic Bone Aspiration To High-Speed Drilling
Authors Shankar VA, Kalyam K, Couch SM
Received 29 June 2019
Accepted for publication 3 October 2019
Published 17 December 2019 Volume 2019:13 Pages 2535—2540
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Vikram A Shankar,1 Krishna Kalyam,2 Steven M Couch2
1Department of Ophthalmology, Wills Eye Hospital, Philadelphia, PA, USA; 2Department of Ophthalmology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
Correspondence: Steven M Couch
Department of Ophthalmology, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, Campus Box 8096, St. Louis, MO 63110, USA
Purpose: Piezosurgical tools utilize high-frequency ultrasonic oscillations to selectively cut mineralized bone and minimize damage to soft tissue and mucosa. The purpose of this study was to directly compare outcomes in external dacryocystorhinostomy (DCR) using a piezoelectric ultrasonic bone aspirator (UBA) versus a high-speed electric drill with a diamond burr.
Methods: A retrospective chart review was conducted on 145 consecutive patients who underwent external DCR by a single oculoplastic surgeon between 2012 and 2017. Collected data included baseline patient characteristics, presenting symptoms, operative details and complications, and postoperative symptoms.
Results: One hundred and seventy-three primary external DCRs performed on 145 patients were included in this study. In total, 61.3% of cases were performed with the UBA and 38.7% with the high-speed drill. Most patients were white (92.4%) and female (67.6%), with a mean age of 57.6 years (range 1–93). Surgical success was achieved in 94.3% of patients in the UBA group and 94.0% in the drill group, with no significant differences between the two arms (p=0.36). Patients who experienced persistent nasolacrimal duct obstruction after surgery underwent endoscopic revision. Operative time was shortened for cases utilizing the UBA (38.9 mins) instead of the high-speed drill (44.7 mins; p=0.01). No significant intraoperative complications occurred in either group.
Conclusion: The UBA offers comparable outcomes and complication rates to more conventional surgical tools for external DCR. Excellent outcomes, ease of adoption, and potential surgical time savings make the UBA an appealing option for both novice and experienced surgeons.
Keywords: piezosurgery, external dacryocystorhinostomy, ultrasonic bone aspiration
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