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In 75% of cases, spinal hernia is amenable to conservative therapy.

But in a number of patients, symptoms cannot be stopped, constant relapses occur, or there are absolute indications for surgical intervention. Endoscopic removal of a hernia of the spine is one of the safest and most effective methods.

Danger of disease

If we compare the spine of a healthy person with a hernia, then the picture will be as follows: in the first case, the cartilaginous discs are even, their edges do not go beyond the vertebral bodies, and in the second, protrusions in one direction or another are noticeable.

Symptoms of a hernia of the spine and its likely consequences mainly depend on the location of the formation.

The most dangerous are posterior hernias directed towards the spinal canal.

Lateral (lateral) often squeeze the nerve roots, disrupting the conduction of impulses from the spinal cord to the brain and provoking severe pain. Possible consequences of impingement, depending on the location of the hernia, are described in Table 1.

Table 1

Spine	Symptoms	Consequences
Sacral	Cauda equina syndrome: pain in the lower back, hips, perineum, weakness in the legs, retention or incontinence of urine and feces. Symptoms can be acute or develop gradually	Paralysis of the legs, intestines, bladder, possibly urine back into the kidneys. Surgical removal required
Lumbar	Lumbago: Sudden, sharp pain on exertion accompanied by muscle spasm. Sciatica: pain and burning in the lumbar region and back of the leg from the side of the root lesion	Compression of the brain leads to partial or complete paralysis
Pectoral	Pain between the shoulder blades, in the sternum, neck, arms. With a hernia in the lower thoracic region, a dysfunction of the gallbladder and pancreas is likely	Possible development of diabetes mellitus, acute myocardial infarction, cholelithiasis, the formation of kidney stones and other severe somatic pathologies
Cervical	Pain in the shoulders, arms, head, dizziness, numbness of the hands, weakness	Brain stroke, paralysis

Without adequate therapy, symptoms can develop gradually from exacerbation to remission until the moment when it is pointless to treat the hernia with conservative methods and removal is required.

Advantages and disadvantages of endoscopic surgery

Endoscopic surgery is a minimally invasive (minimally traumatic) type of surgical intervention, in which all manipulations are performed through an incision up to 2 cm in length without unscrewing skin flaps and dissecting muscles. The high precision, which is essential in spine surgeries, is ensured by visual control under multiple magnification. Special instrumentation introduced by means of a trocar (working port, cannula) guarantees the most accurate excision of pathological tissue.

Consequences of endoscopic removal of a hernia of the spine (why this method is better than other operations):

the thickness of the spinal endoscope is only 6 mm, which allows minimizing trauma to the skin, bypassing muscles, ligaments and nerve roots;
the spinal disc remains intact;
the development of instability of the spinal motion segment in the postoperative period is prevented due to the preservation of bone tissues;
blood loss and risk of infection are minimal. Ultra-high frequency coagulator stops bleeding in aqueous media;
low likelihood of relapse;
the absence after surgery of chronic pain and epidural fibrosis (cicatricial adhesions, as a result of which the rigid fibrous tissue begins to repeatedly squeeze the nerve roots);
shortening the rehabilitation period (you can get up after two hours), reducing the need for analgesics;
no cosmetic defects - a small seam of 7 mm in length remains.

There are times when the operation is ineffective or has some other negative impact. This is due to poor-quality diagnostics, failure to take into account contraindications, insufficient study of the patient's history to identify concomitant diseases.

To date, techniques have been developed for endoscopic removal of most types of vertebral hernias, it is important to choose the right option. In order to avoid a negative result, it is recommended to carry out the operation in specialized centers.

Indications and contraindications

During the preliminary examination of the patient, it is ascertained whether there are any restrictions for carrying out endoscopic removal of the hernia. An extended MRI or CT scan gives a detailed picture of the state of the spine, according to which a decision can be made about the need and possibility of this type of surgical intervention.

Indications for hernia removal:

compression of nerve endings;
lack of positive dynamics from conservative treatment for a month;
sequestered hernia (part of the disc nucleus detached and went beyond the annulus fibrosus);
frequent relapses of pain syndrome throughout the year;
disorders of urination, defecation, sexual function, sensitivity of the legs.

The size of the hernia is not a decisive factor when deciding whether to remove it. Pupils of various academic schools often disagree on which case the operation is performed using the closed method (endoscopy), and which one is open access (laminectomy) and when surgery is not needed at all. Therefore, if possible, it is best to consult with several doctors in independent centers.

Contraindications to endoscopic removal:

the presence of malignant tumors, metastases, active inflammatory processes in and around the spine;
severe cardiovascular pathologies;
pregnancy;
generalized infections;
channel;
the median location of the hernia is in the center of the back of the spine. Access is difficult because the protrusion is hidden behind the nerve roots.

In the above cases, doctors use other removal techniques (laminectomy, microdiscectomy).

Video

Endoscopic spinal hernia removal

Operation progress

Preoperative preparation consists in the patient's refusal to eat and drink 8-10 hours before the intervention. Anesthesia can be either spinal or general. Basically, the first option is used, in which an intravenous infusion of drugs is preliminarily performed through a catheter to prevent side effects (in 3% of cases, headaches are possible within 7-10 days).

The safest and most popular technique for endoscopic discectomy of hernial protrusions is arthroscopic (percutaneous) with transforaminal access (TESSYS system). At the same time, the posterior part of the fibrous capsule and the posterior longitudinal ligament are not damaged, which helps to avoid relapses.

One small incision is sufficient for access, through which a single working port is introduced for both the endoscope and the instruments. Before the operation, doctors carefully examine all available images to accurately calculate the location of the puncture point and the angle of inclination of the working port.

It is important to get into the foraminal holes between the vertebral arches, through which the nerve roots exit from the spinal cord.

Algorithm of actions for hernia surgery using an endoscope transforaminal access is as follows:

On the side of the spine, a 7-8 mm incision is made, into which a working port is installed under X-ray control. It must be positioned correctly to provide access to the desired area.
An endoscope is inserted into the port, after which the image from its camera begins to be displayed on the monitor. Also, constant X-ray control in two projections and flushing (irrigation) of the working area with saline is carried out.
From above, instruments are immersed into the endoscope tube, with the help of which they open access to the hernia, separate and excise its tissues, followed by complete or fragmentary withdrawal to the outside.
The surgeon makes sure that the nerve roots are released. This is evidenced by the change in their color from pale to pink and the appearance of respiratory pulsation. Disc reconstruction is performed using a laser (laser ablation), which helps to avoid relapses and speeds up the regeneration processes.
The instruments are removed, the incision is sutured (one skin suture).

The operation takes 45-60 minutes, in difficult cases - 2-2.5 hours. A day later, in the absence of complications, the patient is discharged under the supervision of a neurologist. The suture is removed after 10 days.

Restrictions on the implementation of transforaminal access:

narrow intervertebral foramen;
moving the sequestration outside the hole;
high position of the iliac crest.

In the presence of the above factors, the removal is performed by the interlaminar method (iLESSYS system) - posterior approach between the vertebral arches.

Complications and rehabilitation

Removal of hernia by endoscopic methods is successful in 96% of cases. Repeated protrusion appears in 4-6% of cases, mainly in the first 2 years.

The likelihood of recurrence depends on the condition of the disc:

the degree of hardening;
the amount of tissue removed;
the degree of rupture of the annulus fibrosus.

If the hernia was located unsuccessfully, then due to the forced displacement of the nerve root within 2-3 days, partial numbness or weakness of the limbs is possible. In such cases, neurotropic therapy is prescribed, the task of which is to provide tissue nutrition.

Of the general surgical complications, the appearance of hematomas is likely (they pass on their own), it is extremely rare for a root injury or infection to occur. Of the specific complications, isolated cases of cicatricial adhesive epiduritis, instability of the spinal segment, and degenerative canal stenosis were recorded.

The rehabilitation program and its duration are determined by the attending physician. In some cases, the patient cannot sit down for some time, since the load on the vertebrae, which increases 200 times in this position, can provoke the prolapse of the remaining disc tissues.

The first week after the removal of the hernia, the patient takes anti-inflammatory drugs. Can also be prescribed "Trental", "Neuromedin", "Furosemide", "Dexamethasone". During the first month, serious physical activity (including swimming, gym), bending is unacceptable, wearing a corset is recommended. After 2 months, swimming, exercise therapy, physiotherapy are allowed.

Complete recovery of the annulus fibrosus and stabilization of pressure inside the disc takes 2 months. After this period, the patient undergoes a control examination to assess the result.

The endoscopic method of removing a hernia allows you to avoid many complications after surgery, and effective methods of recovery will prevent relapses. However, the outcome of surgery is largely determined by the patient's discipline, since only large specialized centers offer a complete rehabilitation program supervised by the attending physician. Regular physical exercises (without heavy weights and sudden movements) to strengthen the muscle corset (press, back extensors), swimming, and maintaining optimal weight will help to maintain the health of the spine.

(1 estimates, average: 5,00 out of 5)

Intervertebral hernia is the most common surgical pathology that forms against the background of progressive chronic osteochondrosis.

Conservative therapy (drugs, exercise therapy, physiotherapy, massage) of an intervertebral hernia does not always give positive results, therefore, the most effective way to treat this disease is surgical intervention. The "gold standard" of neurosurgery in the treatment of intervertebral hernias of various localization is endoscopic removal with a transforaminal approach. This type of surgery refers to minimally invasive (that is, with minimal intervention in the body) surgical methods and allows you to preserve the integrity of bone structures, muscles and ligaments, which reduces the duration of the rehabilitation and recovery period and allows you to quickly return to home and work duties.

An intervertebral hernia is called a protrusion ranging in size from a few millimeters to 1-1.5 cm, which forms in the intervertebral disc as a result of its deformation and displacement of the nucleus pulposus outside the outer shell, consisting of fibrous-connective tissue.

Once in the spinal canal, the pulp (a jelly-like substance containing collagen, chondrocytes and acting as a shock absorber) irritates the nerve endings extending from the spinal cord. If the size of the protrusion exceeds 5-7 mm, compression (squeezing) of the nerve roots almost always occurs, which determines the pronounced neurological symptoms and causes intense pain.

In some cases, the pain syndrome can be so strong that the patient's working capacity and ability to move are sharply limited. In such cases, surgery may be the only way to restore the usual mobility and improve the quality of life of patients diagnosed with herniated disc.

An indication for surgical correction of an intervertebral hernia is also the absence of visible improvements within 3-4 months of active therapeutic treatment. Other indications for endoscopic hernia removal include:

If the hernia is localized in the cervical spine, the decision on the need for surgical intervention may be made earlier than 3-4 months after the start of treatment. In case of severe pain, deterioration of general well-being (severe headaches turning into dizziness, migraine, instability of blood pressure), endoscopic removal of a hernia in the neck area may be recommended after 6-8 weeks of conservative therapy.

Important! The absolute indication for endoscopy of an intervertebral hernia (regardless of the localization of the protrusion) is its sequestration. This is the most severe complication of the pathology, in which part of the nucleus pulposus breaks off from the intervertebral disc and enters the epidural space. If such a hernia is not removed in time, circulatory disorders in the vessels of the spinal cord may occur, which can lead to impaired neuromuscular transmission (paralysis), paresis of the upper and lower extremities and disability of the patient.

The purpose of the operation

Since one of the clinical manifestations of an intervertebral hernia, limiting a person's mobility, is a pronounced pain syndrome, the main goal of surgical treatment is to relieve painful sensations, restore adequate motor capabilities and the ability to physical and professional work. When removing a hernial protrusion with transforaminal access using an endoscope (a medical device in the form of a long tube equipped with an optical fiber), the patient can start performing household and professional duties as early as 2 weeks after the operation, and full physical activity is restored within 1 month.

If you want to know in more detail, preparation for carrying out, as well as consider the types of operations, you can read an article about this on our portal.

In the course of endoscopic removal of a hernia, the following goals are also achieved:

release of compressed spinal endings and elimination of neurological disorders associated with radicular compression;
prevention of the progression of intervertebral hernia (increase in size) and prevention of adjacent surgical pathologies of the spine;
restoration of the normal functioning of the pelvic organs.

The therapeutic effect after endoscopic removal of a spinal hernia is manifested by the disappearance of pain, restoration of muscle strength in the upper and lower extremities, elimination of neurological symptoms: paresthesias, numbness in the legs, lumbago, etc.

Endoscopic method for the treatment of intervertebral hernia: description

Before performing an operation for endoscopic removal of a vertebral hernia, the patient must undergo an X-ray examination or magnetic resonance imaging of the spine. This is necessary to determine the exact localization of the protrusion, its size, position relative to the foraminal foramen, into which the roots of the spinal nerves exit. Obtaining accurate data is of important diagnostic value, since the endoscopic cannula is installed strictly in the area of localization of the hernial protrusion.

Before starting the operation, the patient undergoes local anesthesia with solutions of novocaine or lidocaine (less often ultracaine). General anesthesia is rarely used during operations using an endoscope. The algorithm for further actions is given below.

The patient is placed on the operating table. A special roller or medical pillow is placed under the stomach.
In accordance with the X-ray marking, a small puncture (no more than 7 mm) is performed on the side or along the midline of the spine.
An endoscopic cannula is inserted through the puncture. Under visual control, the hernia is removed and the compressed nerve endings are released.
The endoscope is removed and a suture is applied to the puncture site.

Despite the fact that in most cases there is no need to remove the stitches (the threads dissolve on their own), within 10 days after the operation, some wound care will be required, which consists in the timely replacement of sterile aseptic dressings. After a month, the patient needs to go for a routine follow-up examination to the surgeon who performed the removal.

Video - Endoscopic removal of disc herniation using TESSYS Joimax technology

Benefits of endosurgery of the spine

Endoscopic removal is considered the most gentle method of surgical treatment of vertebral hernias, since the operation is performed not through an incision, but through a puncture of the abdominal cavity, the diameter of which does not exceed 7 mm. This allows not only to avoid injury to muscles and ligaments, but also to reduce the intensity of postoperative pain. Almost 70% of patients who underwent removal of the intervertebral hernia using an endoscope say that the pain after surgery lasted no more than 2-3 days, and their intensity was quite moderate.

Other benefits of endoscopy include:

the possibility of performing the operation under local anesthesia (low risk of side effects associated with the introduction of general intravenous anesthesia);
absence of scars and scars after surgery;
independent resorption of the suture at the puncture site (there is no need to go to the clinic again to remove the threads);
the ability to get out of bed and sit on soft surfaces as early as 2 hours after the operation;
preservation of the bulk of the intervertebral disc (compared to other surgical methods, for example, microdiscectomy, in which the disc is often removed completely).

An important positive point is the possibility of complete visual control, for which a special endoscopic unit with multiple magnification is used. This technique allows you to minimize the possible risks associated with damage to the spinal roots.

Potential risks and consequences

If you want to know in more detail which ones, as well as consider the rehabilitation period, you can read an article about this on our portal.

Endoscopic removal is considered the safest and least traumatic way to treat herniated discs. Despite this, during and after the operation, unpleasant consequences may occur, which are common to any type of surgical intervention on the spine. These include:

Important! In rare cases (less than 1.8%), damage to the spinal cord and spinal nerves is possible, which may result in the patient's disability. To minimize such risks, a reliable fixation of the patient is used, which ensures the immobility of the spine during the operation (especially if the person is conscious).

Endoscopic hernia repair: frequently asked questions

Below are the most common questions that patients are concerned about before surgery. Experts believe that sufficient awareness of the patient about all aspects of the forthcoming treatment and rehabilitation is the key to a successful recovery period and recovery.

How many days do you need to stay in the hospital after surgery?

When removing an intervertebral hernia by the endoscopic method, hospitalization usually takes 1-2 days. If any complications arise during removal or in the early postoperative period, the patient is admitted to a surgical hospital or intensive care unit for at least 7-10 days.

Postoperative bandages prices

Do I need to inject antibiotics after surgery?

The use of antibiotics after endoscopic surgery is in most cases impractical. In order to prevent hospital infections and inflammatory processes, the doctor may prescribe metronidazole for a period of 7 to 10 days at a dosage of 250-500 mg 2 times a day.

The use of antibacterial agents of the penicillin series, cephalosporins, fluoroquinolones and macrolides is indicated for persons with weakened immunity and a high risk of soft tissue infection. The drug of choice is most often "Amoxicillin" (dosage for adults - 500 mg 3 times a day for 5-10 days).

"Amoxicillin"

Is it possible to play sports after the operation?

Professional sports, both after removal of a herniated disc and during conservative treatment, are permissible only with permission. Individual factors that can affect the possibility of sports training are not only the weight and age of the patient, but also the size of the protrusion, the presence of signs of infringement, the localization of the hernia relative to the spinal column and foraminal (intervertebral) foramen.

You can engage in physiotherapy exercises, swimming, gymnastics, muscle stretching exercises 1-2 months after endoscopic surgery to remove a hernia (in the absence of individual contraindications).

Important! In some sources, information can be found that endoscopic removal of an intervertebral hernia does not require any recovery period and restriction of physical activity. This is not true. Endoscopy in the spine is a complex neurosurgical intervention, and, like other methods of surgical correction, requires adherence to a certain regimen for 6-8 weeks after the operation.

Can a pregnancy be planned after endoscopic removal of a spinal hernia?

Endoscopic removal of a hernia of the spine is not a contraindication for planning and carrying a pregnancy, but it is important to consider that any surgical intervention in the body requires a rehabilitation and recovery period. This is especially true when it comes to the spinal column, since it is the lumbar spine that accounts for most of the load during pregnancy, exerted by the constantly enlarging uterus.

To avoid relapses and reduce the risks of osteochondrosis, which affects about 37% of women after carrying a child, it is recommended to plan a pregnancy no earlier than 1 year after endoscopy.

How quickly does leg pain go away after surgery?

Pain in the legs against the background of an intervertebral hernia of the spine disappears immediately after the operation. Muscle weakness, numbness in the legs and other manifestations of paresthesia can persist for a long time (up to several months). In rare cases, these phenomena do not completely disappear at all and require constant correction with medications.

When can I wash myself?

It is possible to wet the seam and wash in the bath or shower on the eleventh day after the operation.

Can you walk?

Prices for orthopedic shoes

Hiking after endoscopy of herniated disc is not only not prohibited, but also recommended as an element of delayed recovery of postoperative patients. It is necessary to walk at a calm pace, comfortable to maintain the usual heart and respiratory rhythm, about 3-4 km per day. 2 weeks after the operation, you can take a leisurely walk for 15-20 minutes a day.

Operation cost

The table below shows the approximate prices for endoscopic hernia repair in large cities.

Prices for endoscopic spinal hernia removal

Corset hyperextension

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Endoscopic nasal polypotomy is a modern and highly effective method for dealing with nasal passages. Thanks to the endoscope, the specialist performing the surgery can view the progress of the procedure through the image displayed on the monitor. The video camera is located at the tip of the surgical apparatus, which is inserted into the nasal passage for complete control.

Endoscopic nasal polypotomy, what is it?

This is what an endoscopic polypotomy looks like.

Surgical intervention is performed using an endoscope. This device helps to get to hard-to-reach places and eliminate growths with minimal trauma to the mucous membrane. If the operation is strictly forbidden to you or you do not want to go under the surgeon's knife, then we advise you to use it for the treatment of polyps

When performing surgery in this way, the risk of recurrence of the disease is reduced. In any case, the specialist will not give a 100% result, and new neoplasms will be able to grow in five or seven years.

At the end of the endoscopic tube there is a video camera that transfers the image to the monitor. Thanks to the complete control of the operation, the specialist can reach hard-to-reach places and remove the polyp with maximum precision, without affecting healthy tissue at a distance of more than one millimeter. If the patient has a curvature of the nasal septum, then during endoscopic polypotomy, this defect can be corrected.

Advantages and Disadvantages of Endoscopic Polyp Removal

When performing a surgical operation in the form of endoscopic polypotomy, there are a number of advantages that must be highlighted:

During the operation, the polyps are completely removed, without the remainder of small pieces, which will soon be able to germinate again.
Surgical intervention is carried out with minimal trauma and with the ability to reach the most inaccessible places in the nasal passage.
After the manipulation, bleeding from the nasal passage is minimal.
The operation takes place without incisions in the mucous membrane, which leads to rapid tissue healing.
Endoscopic polypotomy does not leave scars or scars.
This method is effective for multiple polyps.
In addition to general anesthesia, the patient may be offered local anesthesia.
The postoperative period passes quickly and after a week, in the absence of complications, it is possible to be discharged home.
Edema after surgery disappears in a matter of time, the effect of free breathing can be achieved much faster than when performing another method to remove polyps in the nose.

Disadvantages of endoscopic polypotomy

Despite modern technologies and high competence of the operating specialist, the risk of benign neoplasms in the form of polyposis is preserved, but reduced significantly.

According to statistics, in fifty percent of patients who survived endoscopic polypotomy, new growths formed after seven years. For uncomplicated polyposis, in consultation with the doctor, they are used

Indications and contraindications for removal of polyps in the nose with an endoscope

If there are small growths in the nasal passages, and they do not bring discomfort and do not obstruct breathing, then there is no need to remove them. Endoscopic polypotomy is performed with multiple growths.

The main indications for endoscopic removal of polyps are:

Lack of oxygen caused by blockage of the nasal passages by polyps.
Persistent headaches, reaching migraine, with severe polyposis.
Decreased or completely absent sense of smell.
The appearance of bloody discharge from the nasal passages.
The presence of an unpleasant odor from the nose, similar to putrid.
Change the tone of voice.
Snoring while sleeping.
Polyp formation in both nostrils.
Frequent diseases of ENT organs.
Attacks of bronchial asthma, recurring more and more often.
The presence of defects in the nasal passages, an abnormal structure of the nose and severe polyposis.

Contraindications for endoscopic polypotomy of the nasal passages:

Menstruation at the time of the operation in women.
The presence of an acute respiratory disease in the acute stage.
Purulent discharge from the nasal passages.
Disorders from the blood coagulation system.
The moment of an allergic reaction.
The presence of small growths in the nose.

In order for endoscopic polypotomy to pass without complications, it is necessary to perform an operation according to one of the listed indications, contact a qualified specialist who will appoint several instrumental examinations and pass the necessary tests:

The specialist who will perform the operation will conduct an examination using an endoscope to prevent possible complications and assess the progress of the upcoming procedure. Also, the doctor will collect a complete history, including the presence of chronic and hereditary diseases.

Seven days before the expected date for endoscopic polypotomy, the patient irrigates the nasal cavity with corticosteroid agents. At this time, you should not take acetylsalicylic acid and other drugs that help thin the blood.

In the evening before the operation, it is necessary to have dinner and not eat any more food before the surgery.

Endoscopic surgery for nasal polyps removal

The specialist meets the patient, explains to him the course of the upcoming endoscopic polypotomy.
Depending on the anesthesia chosen at the consultation, anesthesia is delivered through a vein or local anesthesia with sprays and injections. During general anesthesia during all surgical procedures, an anesthesiologist is present in the operating room. A tracheostomy tube is inserted into the patient's mouth. Blood pressure and heart rate are monitored regularly.
During endoscopic polypotomy, a number of surgical equipment and instruments are used. The entire image is displayed on a monitor screen, and the specialist removes the polyps. By agreement, during the consultation, anomalies and defects in the development of the nasal septum and other parts of the nose can be restored in parallel.
The removed polyps are sent to a clinical laboratory for biochemical analysis. There are cases when neoplasms are malignant in nature and the patient needs treatment in an oncological hospital.
After the surgery, cotton swabs are inserted into the nasal passages for one day. After the anesthesia has passed, there is an unpleasant sensation in the nose, which disappears completely after two days. Depending on the course of the rehabilitation period and the conditions of being in the clinic, the patient's stay in the hospital department does not exceed seven days.

Photo gallery:

Postoperative period and rehabilitation

During the classical removal of polyposis, nosebleeds may develop. When performing endoscopic surgery, the development of this complication is almost impossible. In some patients, soft tissue swelling lasts for about two days. In order for the nasal mucosa to heal more quickly and not to have a secondary infection, the patient must follow all the recommendations of the operating doctor and carry out thorough hygiene of the nasal passages.

Important! After endoscopic polypotomy for two days, it is impossible to peel off the formed crusts and blow your nose.

To prevent nosebleeds, the food you eat should be warm, but not hot. On an individual basis, a specialist prescribes a number of medications, including antibiotic therapy.

A doctor's consultation should take place at least once every three months in order to assess the past operation and monitor the condition of the nasal passages.

Cost (price) of endoscopic polyp removal

The pricing policy of endoscopic polypotomy depends on the city, the chosen clinic for the operation, the type of anesthesia and the qualifications of the specialist. In large cities, surgical interventions cost from 13 thousand rubles to 35 thousand rubles.

Video of endoscopic removal of nasal polyps

Endoscopic removal of nasal polyps (polypectomy)- a method of surgical treatment of polyposis rhinosinusitis using endoscopic equipment.

Polyps are benign growths on the lining of the nasal cavity and paranasal sinuses. A disease in which single and multiple polyposis formations are found is called polyposis. The symptoms of this ailment are most often nasal congestion, impaired sense of smell, headaches and deterioration of the general condition. In addition, patients often have snoring, they complain of sleep disorders, coughing.

The most effective treatment for polyposis is a combination of conservative and surgical methods. This is how, in most cases, it is possible to restore normal nasal breathing and prevent recurrence of pathology. Endoscopic polypectomy occupies an important place in the complex of therapeutic measures for the treatment of polyposis.

Basic indications

The main indications for endoscopic removal of polyps are:

lack of a positive reaction to adequate drug treatment;
the presence of persistent or recurrent infections of the nose and sinuses;
the development of mucocele or other complications of polyposis;
high risk of side effects of drug therapy.

Removing polyps using endoscopic techniques is less traumatic for healthy mucous membranes. This method of surgical intervention provides a minimum of relapses compared to the classical loop technique. Thanks to the optics of the endoscope, the ENT surgeon visually controls all his manipulations, observing them on the monitor screen.

How to prepare for the procedure

The decision of the attending physician about the appointment of the operation is based on the data:

anamnesis;
physical examination of the patient;
the results of drug therapy for polyposis;
anterior and posterior rhinoscopy;
CT and MRI of the nose and paranasal sinuses.

Persons with severe heart and lung diseases and bleeding disorders are not allowed to participate in the operation. Intervention for exacerbation of asthma is not prescribed.

Features of the procedure

In most cases, endoscopic removal of nasal polyps is performed under local anesthesia. Persons with increased psychoemotional susceptibility and children can carry it out under anesthesia.

The procedure involves endonasal (through the nasal cavity) introduction of a standard rigid endoscope, incision of polyposis formations and simultaneous revision of the sinuses. The elimination of polyps is performed using a special tool - a shaver. It sucks the polyps into the working channel and crushes them with a sharp rotary knife. After polypectomy with a shaver, the risk of crusting and synechiae in the affected area is reduced.

In the postoperative period, it is necessary to come to the ENT doctor weekly for a month for endoscopic control of wound healing and take endonasal corticosteroids.

A polyp is an outgrowth of the mucous membrane observed in the lumen of hollow organs. They arise in the uterus, nasal cavity, stomach, intestines, etc. These neoplasms can be benign and malignant, therefore, after their diagnosis, they must be removed.

Methods for removing polyps

Previously, removal of polyps was performed only by radical surgery with violation of the integrity of the skin and mucous membrane.

However, a more gentle method is endoscopic removal of polyps, when a special apparatus penetrates through a natural opening or access is provided through an incision.

For example, the intestine or nasal cavity can be penetrated through natural openings, and access to the abdominal organs is most often provided through a puncture of the anterior abdominal wall.

The endoscope for carrying out this type of operation is called depending on the name of the organ that is operated on: a nephroscope is used for the kidneys, a uteroscope for the ureter, and a laparoscope for an operation on the abdominal organs.

The essence of endoscopic polyp removal

The apparatus is a complex design in which there is a tube with a miniature video camera at one end and a monitor at the other. The image is instantly transferred to the large screen. Thus, it is possible to assess the state of the mucous membrane of the investigated organ, the quality of the manipulation performed.

The control panel on the device allows for tissue excision and its extraction from the organ. So you can remove neoplasms in the form of cysts, polyps, tumors.

In the event that access to the organ is provided through a natural opening, then with the help of a tube, specialists approach the organ, then excision of the formation and remove it. In the case of a polyp, a loop is placed at the end of the tube that generates an electrical current. Once the polyp is found, the loop is pulled around the mass and a current is applied, which cuts off the polyp. It is grasped with forceps and pulled out.

The removed polyp is sent for examination to decide whether it is benign. Such formations can arise again, a predisposition to them means registration in dispensary registration and observation.

Benefits of endoscope surgery

Some of the benefits of endoscopic surgery include:

- The manipulation lasts a short period of time, the recovery period takes several days.
After such an operation, there is no scar tissue at the excision site.
There is practically no pain, which inclines people in favor of this method of surgery.

Indications for endoscopic solution of the issue

In order to carry out endoscopic removal of polyps, it is necessary that the size of the formation does not exceed 10 mm, and the diameter is no more than 25 mm.

It is also important that the polyp is formed from glandular and glandular-villous tissue. Other types of masses (more dense) may not be removed by the loop of the apparatus.

It is also important to take into account the absence of contraindications.

Contraindications to endoscopic removal of polyps

Before deciding on a method for resolving the issue, a number of factors are taken into account:

1) Endoscopic removal of polyps is not possible in the presence of a flat polyp.
2) If hemangiomas are additionally present, then the operation is also not performed.
3) In case of a blood clotting disorder, there is no question of removing polyps by any means. Before planning the operation, refuse to take aspirin-containing anti-inflammatory drugs.
4) The presence of severe pathology of the cardiovascular system: heart failure, rhythm disturbances. When installing a pacemaker, you can forget about removing the polyp.

Even though the operation is mild, complications may develop. Most often this is the development of bleeding, which is why it is important to initially determine the size of the polyp.

The endoscopic method allows you to quickly and painlessly solve the issue of removing polyps from hollow organs. The cost of such an operation is more than the classic option, but the discomfort is much less.