The Angelina Dissectors: A Novel Design of Dissectors for Endoscopic Endonasal ApproachesFunding No funding was obtained for this study.
08 February 2019
12 March 2019
12 June 2019 (online)
Background The description and refinement of the transsphenoidal approach would not be possible without new tools and technologies developed by surgeons to facilitate this approach, which is nowadays the standard procedure for more than 90% of sellar lesions. The latest major change in transsphenoidal surgery was the introduction of the rigid endoscope and the subsequent description of the endoscopic endonasal approach. Traditional bayoneted instruments, when used for this technique, were inadequate. New instruments designed, specifically for this technique, are necessary to facilitate the surgeon's work and improve patient outcome.
Objective This study describes a novel design of dissectors created specifically for endoscopic endonasal approaches.
Methods To develop and design the Angelina dissectors, we used our extensive surgical experience to identify the shortcomings of the available dissectors used for transsphenoidal surgery and created the Angelina dissectors.
Results The Angelina dissector was designed with a unique shaft shape which facilitates endoscopic endonasal surgery.
Conclusion Even though an endoscopic endonasal approach is possible using other instruments, the design of these dissectors aids the surgeon's work. It is our impression, based on personal experience that it allows more freedom of movement and dexterity during the procedure, which could translate as an improved patient outcome.
– Ricardo Carrau is a consultant for Medtronic.
– Daniel M. Prevedello is a consultant for Medtronic and Stryker. Daniel M. Prevedello has a royalty agreement with KLS-Martin (related to the sales of the Angelina dissectors), Mizuho, and ACE Medical.
The contents of this manuscript have not been copyrighted or published previously. The images from KLS-Martin publicity material have been used with authorization.
IRB Review Statement/Ethics Guidelines
This manuscript did not seek IRB review or approval.
This is a descriptive study of an Instrument Design based on the author's experience. As such it did not involve any study on patients, chart reviews or data collection, therefore, not requiring an IRB review.
- 1 Hardy J. Reflections on the evolution of pituitary tumor surgery with emphasis on the transsphenoidal approach. In: Laws ER, Lanzino G. , eds. Transsphenoidal Surgery. Philadelphia: Saunders; 2010: 1 3
- 2 Liu JK, Weiss MH, Couldwell WT. Surgical approaches to pituitary tumors. Neurosurg Clin N Am 2003; 14 (01) 93-107
- 3 Lanzino G, Catapano D, Laws ER. History of transsphenoidal surgery for pituitary tumors. In: Laws ER, Lanzino G. , eds. Transsphenoidal Surgery. Philadelphia: Saunders; 2010: 4-9
- 4 Hirsch O. Endonasal method of removal of hypophyseal tumors - With report of two successful cases. J Am Med Assoc 1910; 55: 772-774
- 5 Cushing H. The Weir Mitchell lecture: surgical experiences with pituitary disorders. J Am Med Assoc 1914; 63: 1515-1525
- 6 Dott NM, Bailey P, Cushing H. A consideration of the hypophysial adenomata. Br J Surg 1925; 13: 314-366
- 7 Guiot G, Thibaut B. L’exérèse des adénomes de l’hypophyse par voie trans-sphénoïdale. Adénomes Hypophysaires. Paris: Masson; 1958: 165-180
- 8 Doglietto F, Prevedello DM, Jane Jr. JA, Han J, Laws Jr ER. Brief history of endoscopic transsphenoidal surgery--from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurg Focus 2005; 19 (06) E3
- 9 Liu JK, Das K, Weiss MH, Laws Jr ER, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg 2001; 95 (06) 1083-1096
- 10 Rhoton Jr AL. Operative techniques and instrumentation for neurosurgery. Neurosurgery 2003; 53 (04) 907-934 , discussion 934
- 11 Carrau RL, Jho HD, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 1996; 106 (07) 914-918
- 12 Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997; 87 (01) 44-51