Endoscopic sinosurgery yet to gain momentum
Nidhi Srivastava - New Delhi

Despite its high success rate, endoscopic sinosurgery is yet to catch up in the country. Not only are there very few doctors trained to perform the surgery, there is also low awareness on this option available.

According to a handful who perform this surgery, there are three formidable factors such as technology, cost component and lack of awareness, that prevent this specialised surgery technique from becoming common in India.

Technology, the laser itself

KTP (Potassium titanil phosphate) is a solid crystal laser, extremely versatile in nature. It is portable and causes practically no tissue destruction unlike a knife or an electric rod. Also, it can be transmitted along with a small fibre to any part of the body. “The biggest advantage of this laser is its coagulation characteristic. Since KTP has a frequency that is very close to the frequency of haemoglobin absorption, KTP can cause almost immediate coagulation. Finally, the result is a bloodless operation. Laser does three things, it cuts, vapourises and coagulates the tissue to stop bleeding,” says Dr S K Kaluskar, visiting ENT specialist, MAX Healthcare.

Treatment cost

The latest treatment available is slightly expensive — usually between Rs 19,000 to Rs 30,000. “But its success rate is as high as 95 per cent,” says Dr Kaluskar.

Then and now

Earlier the only treatment available was washing the sinuses and the apparatus in use was a speculum that provided a view of a very small area inside the nose. However, in the last 18 years as the technology developed, inventions like Hopkins Rod System (telescope), endoscope, C T Scan, etc., helped tremendously towards the treatment of sinusitis.

Advantages of laser

The latest available treatment, KTP/ 532 endoscopic sinosurgery makes use of these advantages. “Because one is working so closely with important structures of the eyes and brain, he needs to know exactly where he is going. In the past, people including me, considered the sinuses below the eyes and in front of the ears as the main problem causing areas. However, it is not so. It is the sinuses that are above the eyes - the ithmoid sinus. Earlier, we would simply wash the sinuses out, but with ithmoid if one performs in ordinary light, there are chances of reaching somewhere near the eyes and pulling out muscles, thus giving way to complications,” explains Dr Kaluskar.

It is necessary to see the structures like brain, optic nerves, eyes etc, he says. “The more the surgical landmarks you can see the lesser the chances of serious complications,” he adds. Another complication that might occur is damage to the brain by leakage of its duramater.

Expertise

For endoscopic sinosurgery to be completely successful, it is extremely important that the surgeon is well-trained. “A lot of hand to eye co-ordination as well as an experience of performing on a couple of cases is required to excel in this surgery,” says Dr Sanjay Sachdeva, ENT Specialist, Max Healthcare.

“Only then will he fulfill the essential requirements of taking the complete medical history, analysing each symptom, thoroughly examining the nose with a telescope, and then giving a proper diagnosis,” he adds. Also, insists Kaluskar, a follow up of the patient is extremely important. After that, the patient needs to consult his doctor after six months to one year period depending on the situation, because usually a treatment is not a cure forever, he says.