Endoscopic pilonidal sinus resection (EPSI-R): a new method
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Endoscopic pilonidal sinus resection (EPSI‑R): a new method B. C. Yuksel1 · Y. Aslan2 · S. Er1 Received: 22 March 2020 / Accepted: 13 May 2020 © Springer Nature Switzerland AG 2020
In our video presentation, we describe a new method of endoscopic resection of the sinus cavity using a bipolar resectoscope (EPSI-R) Informed consent was obtained from the patients for the procedure and the video The technique involves the use of a 26-F bipolar resectoscope (TURis 2.0, 30°), an obturator (Fig. 1a) for the entry of the resectoscope (Fig. 1a), and an electrosurgical generator (Olympus ESG-400, Tokyo, Japan) with a U-shaped cutting loop (Fig. 1b). The generator was programmed to run on 200 W power for cutting and 120 W for coagulation. The resectoscope was used with saline irrigation. This bipolar resectoscope is normally used in the transurethral treatment of the prostate. The patients were given a single dose of prophylactic antibiotics (1 g cefazolin). The operation was performed under epidural anesthesia with the patients in the prone position and buttocks separated by adhesive tape. The surgeon stood on the left side of the patient. After the area was sterilized and covered, the presence of any secondary fistula and/or abscess was examined. Following the setting up of the system, the pit was located and expanded to the extent that allowed the entry of the resectoscope using Kelly forceps. A single midline incision was made. After entering the cavity, the area was made visible using saline infusion to evaluate the topography of the cavity (Video). Resection was started systematically from the farthest point. The cavity wall was resected with Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10151-020-02243-4) contains supplementary material, which is available to authorized users. * B. C. Yuksel [email protected] 1
Department of Colon & Rectum Surgery, University of Health Science, Ankara Bilkent City Hospital, General Surgery, Çankaya, 06800 Ankara, Turkey
Department of Urology, University of Health Science, Ankara Bilkent City Hospital, Ankara, Turkey
2
an approximately 1–2 mm thickness. The excised tissue was removed by saline pressure. Following hemostasis, the cavity was checked in terms of remaining debris, and the area was completely cleaned. After the resection procedure was completed, the saline left in the cavity was evacuated, and the area was lightly swabbed with 80% phenol. This process was repeated after 10 days. The size of the cavity was 10 × 6 cm in both cases and loculations were found in one case, surgery lasted 22 and 30 min. Both patients were discharged the same day of surgery and both returned to work on the forest postoperative day. Complete healing was achieved at 25 and 35 days, respectively. Neither of the two patients experienced a recurrence during a follow-up of 8 months. Conventional surgical techniques, such as open healing and primary closure or flap methods cause large and deep wounds, as well as disabl
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