Endoscopic surgery to remove the intervertebral hernia. How is an endoscopic nasal polypotomy performed? Indications and contraindications

05.11.2019 -

After the patient is diagnosed with nasal polyposis, the main method of facilitating nasal breathing and reducing symptoms, today are only surgical methods in combination with further medical treatment.

The formation of polyps is based on the release of histamine and other inflammatory mediators, which, destroying and causing swelling of the epithelium, begin the formation of a polyp, after which the glandular tissue of the mucous membrane changes.

When a person with polyposis has a disorder of smell, the absence of nasal breathing, which greatly reduces the quality of life, exacerbations and seizures become more frequent bronchial asthma, snoring and headaches appear - this is an indication for surgical removal nasal polyps.

Operations in progress today different ways, and methods are still used that are quite painful and traumatic - these are polypotomy and removal of the polyp loop. These methods are accompanied by bleeding and a long postoperative recovery period, moreover, the disadvantage of their use is that only polyps located in the nasal cavity can be removed in this way, and as a rule, almost all polyps originate in the paranasal sinuses.

With the inaccessibility of polypous tissue in the sinuses after such methods of removal, neoplasms form again very quickly in the next 1-2 years. Therefore, the most modern, progressive technology is endoscopic surgery using a shaver.

Endoscopic removal of polyps

Functional endoscopic sinus surgery or Functional Endoscopic Sinus Surgery is an innovative technique based on the use of modern endoscopic equipment. This allows otolaryngologists to perform surgical manipulations with a minimal risk of complications and a lower degree of injury. When carrying out such a removal, benign neoplasms are completely removed, which reduces the risk of recurrence by 50%, and healthy tissues are not subjected to unnecessary trauma.

When choosing a method and a surgeon, what should you pay attention to? Choose an Endoscopic FESS operation, i.e., so that the use of a shaver or microdebrider occurs under navigation control - this is the most modern and effective method, because without a navigator, it is quite difficult to clean all the chambers of the lattice labyrinth. If this is not done, after 3-6 months the “mycelium” of the polypous tissue can again grow new polyps, since the remaining polypous tissue, like the mycelium, creates the conditions for the formation of new polyps. And the patient enters the pipeline of new operations and financial expenses. It is also very important that the doctor performing endoscopic surgery perform such operations regularly and have extensive experience with this equipment.

There are 3 ways to remove polyps:

endoscopy, instruments - without a shaver it is difficult to clean deep and small cells
endoscopy, shaver
endoscopy, navigation, shaver — the safest method

If the patient is shown surgery, but he has a period planned operation exacerbation of bronchial asthma or obstructive bronchitis, as well as during the seasonal period - the operation should be postponed and performed only during the remission period. Also contraindicated surgical intervention at:

Heart failure, ischemic heart disease
Serious diseases of the internal organs
Acute infectious diseases
Even a slight malaise, a cold, an increase in blood pressure should be a reason for postponing the operation.
Aggravation allergic reactions and bronchial asthma

Advantages and disadvantages of the method

The advantages of endoscopic surgery are that it does not require any incisions, the whole process is carried out through the nose - endonasally.
Using endoscopic equipment the operating surgeon sees what he is doing on the monitor and has access to all inaccessible parts of the sinuses and nasal cavity, which is not possible with conventional surgery.
Such precise devices as a debrider or a shaver work with minimal trauma to healthy tissue and mucosa, with millimeter accuracy.
Minimal bleeding is also an advantage.
This operation is performed in a hospital and takes the patient 3-7 days.
Almost 80% of patients are satisfied with the results, because they experience great relief, they leave those symptoms that they had before the removal of polyps with an endoscope.

Disadvantages: Any operation to remove nasal polyps does not eliminate true reason their occurrence, therefore, the re-pathological growth of polypous tissue occurs quite often, in 50% of patients. But this usually happens a few years after a successful operation.

How is endoscopic surgery performed?

Endoscopic removal is carried out by means of endovideosurgical visualization with screening of the surgical field on the monitor. In this case, special modern tools are used:

A debrider (shaver, microdebrider) is a device that draws polyp tissue into its tip and shaves it at the base.
Headlight
Endoscope with optics with different angles of inclination
Special nasal mirrors

The operation is performed under general anesthesia, its duration and complexity depend on clinical picture polyposis and the number of sinuses in which drainage should be improved and fistulas should be opened. Affordable visualization and high accuracy of the shaver allow the most thorough removal of polypous tissue and polyps in all parts of the nasal cavity and paranasal sinuses. Therefore, after such a procedure, the remission time increases, relapses are recorded less frequently and after more long time than after other surgical methods.

Purifying paranasal sinuses thus, it is simplified and becomes the most effective further postoperative treatment and holding re-interventions to remove new growths. How is endoscopic removal of nasal polyps performed with a shaver?

After the introduction of anesthesia, the patient falls asleep after a few minutes. The anesthesiologist places a plastic tube through the mouth into the trachea to allow breathing during the operation. Both heartbeat and respiration are recorded during the operation. Insofar as modern technology allows removal through the nostrils, no incisions are made, endoscopes and illuminators are used for a better examination of the nasal cavity.

With the help of special bone instruments, as well as suction - a shaver or a debrider, the paranasal sinuses are opened, from which all modified tissues, polyps that block fistulae are removed. If an endoscopic FESS is performed, the surgeon both removes the nasal polyps and can correct the deviated nasal septum and take biopsy tissue and open the sinus fistula. After the operation, special tampons are left in the nasal cavity, they are removed the next day in the morning.

Preoperative preparation

Before any surgical intervention, it is very important to conduct a thorough preoperative preparation:

Discussed during the consultation required list tests to be performed on the patient. Be sure to do a CT scan of the paranasal sinuses, a coagulogram, a general and biochemical analysis blood. It should also be determined whether the patient needs prior endoscopic examination to determine the scope of work and technically difficult areas in advance, this will help the surgeon both reduce time and improve the quality of the operation.

7 days before surgery

If the patient has severe nasal polyposis, prednisolone 40 mg every day is prescribed a week before the planned operation. With an active infection in the nasal cavity, an anti-inflammatory drug is prescribed. antimicrobial therapy. Also, NSAIDs, aspirin, vitamin E, which affect blood clotting, are excluded for a week.

One day before surgery

On the eve of the operation, a light dinner is allowed in the evening, and for 6 hours you can neither drink nor eat, with, you can only rinse your mouth with water.

Postoperative period

After any surgical intervention, it takes time for the nasal mucosa to recover. Since the activity of the ciliated epithelium decreases in the period after the operation, the circulation of mucus in the nasal cavity is disturbed, which increases the risk of penetration and reproduction. various infections Therefore, nasal hygiene is very important. The next morning, the patient is removed tampons, while in the nasal cavity there is an accumulation of crusts, blood, fibrin plaque is formed.

At this time, in no case should you blow your nose, take hot food. It is only necessary to carefully remove mucus and crusts from the vestibule of the nose. Usually nasal breathing returns quickly, and the sense of smell is restored sometimes within a month. Doctors consider that the operation was successful if symptoms such as blockage of the outflow in the nasal cavity are observed - this is a headache, and pain in some parts of the face.

Possible complications after surgery:

Infectious complications
Bleeding
Adhesions and formation of adhesions in the nasal passages
Re-growth of new nasal polyps.

Anti-relapse postoperative treatment:

Since any method of removal does not eliminate the causes of tissue growth, therefore, postoperative anti-relapse treatment is suggested. (cm. ). After the operation, already at home, the patient can wash the nose with ready-made pharmaceutical products, such as Physiometer, Aquamaris, Dr. Theis Allergol, Marimer, Physiomer, Quicks, Atrivin-More, Gudvada.

You should also take antihistamines-, Zodak, Erius, Loratadin, Claritin (list of the best modern ones).

After the operation, dosed hormonal aerosols are always prescribed, such as Flixonase, Nazarel, Asmanex, Aldecin, Avamys, Benorin, Nasonex, Baconase, Rinoclenil, Nasobek, Beclomethasone.

Also, allergy sufferers with pollinosis should follow a diet, especially during the flowering period of allergenic plants, according to the list of products that cause cross-allergy (see table in the article and).

Over the next year, the patient should be seen by an otolaryngologist every 3 months, and allergy sufferers should also be seen by an immunologist-allergist. If nasal polyps are not caused by hay fever, then after surgery and after drug anti-relapse treatment, supplement with homeopathic or.

Removal of polyps with a polyp loop

Special forceps or polyp snare is also a method used in some clinics. The disadvantage of this method is the pain of the operation, because local anesthesia cannot penetrate deep into the sinuses and only those polyps that have fallen out of the sinuses into nasal cavity. And most polyps grow from the paranasal sinuses, so this method is not effective and relapses occur quite quickly. It is also a very atraumatic method with significant bleeding.

laser removal

This is a more progressive method, less traumatic than loop removal, practically bloodless. (cm. ). It can be performed under local anesthesia on an outpatient basis, the procedure takes only 20 minutes. But a significant drawback is that only single polyps are removed in this way; with multiple polyposis, this method is not used.

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 in nature, therefore, after their diagnosis, they must be removed.

Polyp removal methods

Removal of polyps was previously performed only by radical surgically with violation of the integrity of the skin and mucous membranes.

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

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

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

The essence of endoscopic removal of the polyp

The device is a complex structure, 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 big screen. Thus, it is possible to assess the state of the mucous membrane of the organ under study, the quality of the manipulation.

The control panel on the apparatus allows excision of the tissue 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 excise the formation and remove it. In the case of a polyp, a loop is placed at the end of the tube, which generates electricity. After the polyp is detected, the loop is tightened around the formation and current is applied, which cuts the polyp. It is grasped with forceps and brought out.

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

Benefits of surgery with an endoscope

Here are some positive points in favor of endoscopic surgery:

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

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 not more than 25 mm.

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

It is also important to consider the absence of contraindications.

Contraindications to the removal of polyps endoscopically

Before deciding on a method for solving an 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 violation of blood coagulation, we are not talking about removing polyps in any way. Before planning the operation, refuse to take aspirin-containing anti-inflammatory drugs.
4) The presence of severe pathology of cardio-vascular system: heart failure, rhythm disturbances. When installing a pacemaker, you can forget about removing the polyp.

Even though the operation is easy, 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 resolve the issue of removing polyps from hollow organs. The cost of such an operation is more than the classic version, but the discomfort is much less.

Endoscopic removal of intervertebral disc herniation means manipulation of the “fallen off” disc fragment without incisions. This minimal surgical intervention skin covering with a minimal destructive effect is carried out purposefully to eliminate disc tissue, which is partially displaced beyond the normal area between the vertebrae. A modern and efficient method for providing medical care with this disease.

According to the forms of manifestation of hernial formation on the disc, there are three stages: protrusion, extrusion and sequestration. They are formed on the spine, depending on the degree of displacement and changes as a result of blood flow disorders in a particular area and a number of factors (for example, osteochondrosis). As a result, there is a lack of nutrition and fluid supply to the tissues, and then the appearance of small cracks.

Protrusion

It is observed in cases when the disk "bulges out", causing pain in the surrounding area, due to compression of the nerve bases and is accompanied by pain sensations (vessels, ligaments, muscle tissue). In this case, the maximum distance along any planar direction beyond the end of the disk is smaller than between its edges.

Extrusion

The phenomenon of an extrusive nature is observed much less frequently with "protrusion" together with a violation at the edges of the disc material during prolapse of the inner part (core), held only by the longitudinal ligament with the spine. The most dangerous is the presence in the lumbar region, which often leads to pain in the sciatic nerve.

Sequester

In the case when the continuous connection with the disk tissue of the displaced material is completely lost, a form of the disease manifests itself - sequestration.

hernia symptoms

The manifestation of the presence of disorders in the disc tissues or the formation of a hernia in the spine is most often accompanied by a number of factors. They are:

Severe pain, which can be expressed as breaking, itching, burning or shooting. Their initial manifestation may be concentrated in the region of the waist, buttocks or hip joint. Subsequently, to be given in the femoral part or ankle.
Impaired perception of sensitive sensations in the legs.
Manifestation of weakness in the limbs.
Violation of activity in the pelvic area and its organs (signs of abnormal urinary excretion with delays, sexual dysfunction).

Diagnostics

Magnetic resonance imaging (MRI) is a fairly complex, but safe and effective methodological procedure for diagnostic purposes. At the same time, it is in no way connected with the use of ionizing radiation or any radioactive effects of substances. Only properties apply magnetic field together with radio frequency pulses.

This method allows you to examine the patient in the tunnel-shaped compartment of the tomograph. To date, it is considered the most effective diagnostic method for detecting progressive chronic abnormalities in the spine and herniated discs in special cases.

The advantage of such an examination lies in the most subtle detailed study, as soft tissue, and disk structure, including the presence of a rupture of its annular structure, nerve bases, spinal cord substance. The visual perception of the affected areas by doctors eliminates ambiguities in the treatment of many problems in the spine to the fullest extent.

Depending on the need, you can carry out:

Myelography CT;
Do a survey and functional x-ray;
Conduct an accurate assessment of the state of muscle tissues and nerve bases that are closest to the damage;
Temporarily turn off one link from the full reflex pain state; make a discography on a provocative basis.

Surgery

This treatment is given when diagnosing pain symptoms arising from squeezing for three or four weeks. It is also used with an increasing increase in signs of weakness, withdrawal, regardless of how long the disease occurs. If a violation of actions in the pelvic region is detected, then surgical intervention is immediately performed.

Today, the most famous are the most methods that are associated with the introduction of a substance into the cavity area of the human body. That is, intramuscularly or intravenously. At the same time, the effect of surgical intervention is felt much faster in case of degenerative diseases in vertebral hernial formations, and regression of pain sensations is achieved.

The most gentle of existing methods, which allows you to fully carry out the removal of a new formation without complications in the intervertebral disc of the lower back - this is endoscopic. It is called "percutaneous".

The operation is performed using a complex device, the main elements of which are a combination of high-precision optics and a working channel. An endoscope of only 7 mm in diameter is sufficient for an effective and efficient operation.

The intervertebral neoplasm is removed along the canal where the connection between spinal cord nerve base. An electron-optical device controls the course of the needle both outside the canal and subsequently along it. Then the endoscope tube is inserted and the disc and sequester are partially removed, which presses the nerve base and causes pain. This further allows intervertebral disc correctly perform depreciation functions. And due to the disappearance of the radicular neurological syndrome, sharp pains disappear.

Polyps are one of the varieties of benign skin neoplasms. Their appearance is not associated with the degeneration of the skin cells themselves, but is caused by tissue hypertrophy, that is, their significant growth. Nasal polyps are one of the most common complications chronic rhinitis. They are abnormally overgrown mucous membranes of the nasal passages, and may look like peas, bunches of grapes, or mushrooms.

It may seem that, due to their good quality and the absence of a significant growth rate, nasal polyps do not pose a particular danger to their “owner”. However, firstly, they give him constant discomfort, as a person always feels difficulties in the process of breathing. Secondly, as statistics show, the presence of nasal polyps can shorten the life of the affected person by 3-5 years, because, due to obstruction in the nose, he constantly has to breathe through his mouth, which increases the likelihood of developing asthma and other respiratory diseases.

Nasal polyps: what are they and why should they be treated?

The formation of polyps occurs due to the release of substances-histamines - inflammatory mediators. These elements cause swelling and destruction of the epithelium, due to which the process of changing the glandular tissue of the mucosa begins, and a polyp begins to form.

Hypertrophy of the mucous membranes of the nasal cavity usually goes through three stages. First, the resulting polyps have small size, and their carrier does not feel their presence, because they do not interfere with breathing. Further, polyps gradually increase, blocking a significant part of the respiratory tract. The most neglected case is when the polyps grow so much that they completely block the cavity of the respiratory tract, and the person cannot breathe through the nose at all.

Approximately 4% of the world's population suffers from such an ailment, and in men it is diagnosed more often. In children, polyps of the mucous membrane lining the maxillary sinuses(anthrochoanal), and in adults - polyps of the ethmoid labyrinth, or ethmoid polyps.

Such neoplasms in the nasal passages significantly interfere with normal breathing processes. What is dangerous for a person to constantly breathe through the mouth?

When breathing takes place through the nose, the normal way, the air is moistened, warmed and cleaned from various particles of debris and dust before it enters the respiratory tract. Foreign particles settle on the mucosa, getting stuck in microscopic villi, after which they are removed in a natural way. Due to a violation of nasal breathing, the air entering the lungs does not go through the process of purification and warming, which can provoke such diseases:

pharyngitis;
tracheitis;
pneumonia;
bronchitis;
laryngitis;
laryngotracheitis.

Due to the violation of the natural communication of the sinus cavities, the patient is accompanied by chronic sinusitis.

Growing tissues put pressure on the blood vessels in the tissues of the nasopharynx, due to which a person develops inflammation of the tonsils, adenoids form, symptoms of tonsillitis appear with an increase in the palatine tonsils. Pressure on the auditory tube contributes to the development of otitis media.

Symptoms of nasal polyps: how to recognize the disease

The main symptomatology is characterized by difficulty in nasal breathing - a person experiences a feeling of constant nasal congestion, while not a single medicine in the form of drops, nasal ointments or tablets do not help to cope with it.

Among other manifestations:

increased production of mucus, sometimes with purulent impurities;
frequent sneezing;
the appearance of headaches;
deterioration of the sense of smell, when overgrown tissue interferes with the work of receptors;
the appearance of an unpleasant aftertaste in the mouth if the polyps have reached large sizes;
the appearance of nasality and voice changes;
the presence of polyps in the first year of a baby's life can cause the development of malocclusion.

When the growth of polyps reaches the most advanced stage, a person, against the background of general nasal congestion and constant discharge from the nose, feels unwell, weak and fatigued.

Treatment of nasal polyps: is it necessary to remove neoplasms

Given the consequences of the development of the disease, and the feeling of constant inconvenience that it delivers, the need for treatment of polyps is beyond doubt.

Today, medicine offers several methods for the treatment of nasal polyps. Conservative therapy involves drug treatment to eliminate infectious inflammatory processes in the nasal respiratory tract, the exclusion of factors that provoke the growth of polyps, for example, exposure to allergens, as well as dietary restrictions, regular washing of the nasal cavity and doing special exercises. Hormonal drugs may also be used for treatment.

Rejection of polyps can be achieved by heating them quartz lamp up to a certain temperature.

Polyps are dangerous for their complications - sleep apnea, exacerbations of asthma attacks, development chronic sinusitis. Removal of polyps requires surgical intervention, however, if conservative methods of treatment do not help, and the disease has reached advanced forms, surgery becomes a necessity.

Polyp removal techniques: indications for endoscopic surgery

The most commonly prescribed methods for getting rid of polyps include laser removal and endoscopic removal of nasal polyps. In the first case, the doctor burns out the neoplasms with a laser beam.

An endoscopic procedure can be carried out according to three schemes:

“endoscopy with instruments”;
“endoscopy with shaver”;
“endoscopy, navigation, shaver”.

Functional endoscopic surgery of the nasal cavity is based on the use of modern endoscopic equipment. For the implementation of the intervention, it is not necessary to make large incisions or violate the integrity of the cartilaginous and bone structures. Using an endoscope, it is possible to remove polyps with a minimal risk of complications or injuries.

Most the best option surgery is a type of endoscopy with a shaver and navigation - in this case, you can most effectively clean the cribriform labyrinth of the mucosa to reduce the likelihood of recurrence of nasal polyps.

The main indication for removal endoscopic method- diagnosed polyps in the nasal cavity, if they do not respond well conservative therapy. In each case, the doctor decides whether it is expedient to carry out surgical intervention in the nasal cavity.

Endoscopic removal of polyps has a list of relative contraindications, for example:

exacerbation of obstructive bronchitis and asthma;
allergic rhinitis;
seasonal hay fever in allergy sufferers;
pregnancy;
cold, fever and blood pressure.

After the listed conditions are stopped and remission is achieved, or after the end of the pregnancy state, the patient is allowed to undergo surgery.

Absolute contraindications are:

heart, liver and kidney failure;
infectious and inflammatory diseases;
some diseases of the internal organs.

Technique for endoscopic removal of nasal polyps

A week before the scheduled date, the patient needs to stop taking certain drugs and substances - aspirin, non-steroidal anti-inflammatory drugs. If the patient's polyposis has an advanced form, he may be prescribed 40 mg of prednisolone daily.

No liquids or food should be taken 6 hours before the operation, and dinner the night before should be light.

Removal is carried out only in a hospital, in which the patient will need to stay 3-4 days after it.

Before starting the intervention, the doctor cleans the nasal cavities from the fluid and mucus accumulated there - suction can be used for this purpose.

The operation begins after the introduction of the patient into a state of medical sleep, for which he is given intravenous injection anesthesia. The operated person is connected to devices that record his condition, heartbeat, respiration and other vital signs.

The following tools can be used in the process:

shaver, debrider or microdebrider: a device that draws in the “top” of the neoplasm, while simultaneously shaving it off at the base;
nasal mirrors;
endoscope with illuminator and camera, or with special optics.

The surgeon performs all actions, guided by the image that the endoscope inserted into the nasal cavity displays on the monitor. The success of the operation depends not only on the qualifications of the doctor, but also on how complete the visualization of the surgical field is, and how accurate the shaver is.

Through oral cavity a special breathing tube is installed in the trachea of the operated person. The opening of the paranasal sinuses occurs due to the use of bone instruments and, in fact, a shaver - suction. All overgrown tissues and polyps that block the patency of anastomoses are removed from the cavities. If necessary, the doctor may also repair the nasal septum and take tissue for biopsy.

At the end of the operation, sterile swabs are placed in the nasal cavities, which can be removed the next day.

Recovery after surgery: the rules of rehabilitation

The main requirement of the postoperative period is to provide full recovery and mucosal healing. Due to surgical intervention in the nasal cavity, there is a decrease in the activity of the “cilia” of the epithelium, as a result of which the circulation of mucus through the cavities worsens, and the risk of developing an infectious lesion increases.

After the patient removes the tampons the next day after the operation, crusts, dried blood, and fibrin deposits form at the site of the removed polyps. It is impossible to blow your nose and remove these formations by force, as long as it is forbidden to take hot food. Mucus and crusts can be gently removed only from the vestibule of the nose.

Nasal breathing usually returns within the first week after surgery, but the sense of smell may disappear for a month and a half. Doctors evaluate the effectiveness of the operation by the development of outflow blockade in the nasal cavity - if the patient begins to experience headache and pain in some parts of the face, the removal of polyps can be considered successful.

It should be noted that the very fact of removing the overgrown mucosal tissue is not a deliverance from the causes that provoke such growth, therefore, in about 40-50% of cases, patients experience a relapse of the pathology, with a good prognosis and following the rules of rehabilitation - after 2-4 years.

At home, after the operation and at the end of the wound healing process, the patient needs to periodically rinse the nose special preparations- Aquamaris, Aqualor, Marimer, or other similar means.

People suffering from allergies are shown a special anti-allergic diet.

During the year, the patient needs to come every three months for a preventive examination to the otolaryngologist, allergy sufferers - to and to.

Endoscopic surgery for the removal of polyps has a number of undeniable advantages - it does not require skin incisions, crushing of bone structures and other serious interventions in the nasal cavities. Thanks to the unique equipment - the endoscope - the doctor gets the opportunity to access the most hard-to-reach areas of polyps with tools. In this case, injury to adjacent healthy tissues will be minimal. Approximately 80% of patients note that relief after surgery occurs already on the second or third day. The only but most significant disadvantage endoscopic removal nasal polyps in that it does not allow you to get rid of the very cause of the appearance of polyps, so the likelihood of their recurrence is extremely high.

Endoscopic nasal polypotomy is a modern and highly effective method in the fight against 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 device, which is inserted into the nasal passage for complete control.

Endoscopic polypotomy of the nose, what is it?

What does an endoscopic polypotomy look like?

Surgery is performed using an endoscope. This device helps to reach 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, a 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 full control of the operation, the specialist can reach hard-to-reach places and remove the polyp with maximum accuracy, without affecting healthy tissues at a distance of more than one millimeter. If the patient has a deviated nasal septum, then this defect can be corrected during endoscopic polypotomy.

Advantages and disadvantages of endoscopic polyp removal

Fulfilling surgical operation in the form of endoscopic polypotomy, there are a number of advantages that need to be highlighted:

During the operation, there complete removal polyps, without the rest of the 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 healing fabrics.
After endoscopic polypotomy, scars and scars do not remain.
This method is effective for multiple polyps.
Apart from general anesthesia The patient may be given a local anesthetic.
Postoperative period passes quickly and within 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

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

According to statistics, in fifty percent of patients who survived endoscopic polypotomy, new growths formed after seven years. In uncomplicated polyposis, in agreement with the doctor, apply

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

If there are growths in the nasal passages small size, and they do not bring discomfort and do not make breathing difficult, 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.
Constant headaches, reaching migraine, with severe polyposis.
Decrease or complete absence smell.
Appearance spotting from the nasal passages.
Availability bad smell from a nose similar to putrid.
Changing the timbre of the voice.
The presence of snoring during sleep.
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 surgery in women.
The presence of an acute respiratory disease in the acute stage.
Purulent discharge from the nasal passages.
Disorders of the blood coagulation system.
moment of an allergic reaction.
The presence of neoplasms in the nose of a small size.

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

The specialist who will perform the operation will examine with an endoscope to prevent possible complications and evaluate the progress of the upcoming procedure. Also, the doctor will collect a complete medical 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 corticosteroids. At this time, you can not take acetylsalicylic acid and other drugs that help thin the blood.

On the evening before the operation, it is necessary to have dinner and no more food until the surgical intervention.

The course of the operation for the removal of nasal polyps by the endoscopic method

The specialist meets the patient, explains to him the course of the upcoming endoscopic polypotomy.
Depending on the anesthesia chosen during the consultation, it is administered through a vein or local anesthesia with sprays and injections. When conducting general anesthesia An anesthesiologist is present in the operating room during all surgical interventions. A tracheostomy tube is inserted into the patient's mouth. The control blood pressure and the number of heartbeats is carried out regularly.
During endoscopic polypotomy, a number of surgical equipment and instruments are used. The entire image is displayed on the 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.
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 surgery, cotton swabs are inserted into the nasal passages for one day. After withdrawal of anesthesia, there is unpleasant feeling in the nose, which disappears completely after two days. Depending on flow rehabilitation period and the conditions of stay 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 a secondary infection does not join, the patient must follow all the recommendations of the operating doctor and carry out thorough hygiene of the nasal passages.

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

To prevent nosebleeds, food should be warm, but not hot. On an individual basis, the specialist appoints 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. AT major cities surgical intervention is carried out at a cost of 13 thousand rubles to 35 thousand rubles.