A case of Dr. André Felippu, from the Felippu Institute
In the field of surgical training, app SurgSchool It has become an invaluable tool for health professionals. Recently, we uploaded a video of the Dr. André Felippu, from the Felippu Institute in Sao Paulo, Brazil, presenting centripetal endoscopic sinus surgery to treat sinonasal polyposis. This procedure is an excellent example of advanced and meticulous techniques in sinus surgery. The highlights of this intervention are detailed below.
Preoperative Analysis
Dr. Felippu begins the video by showing a CT scan of the paranasal sinuses, highlighting the importance of looking at both complete sides of the pathology, the height of the skull base and the orbit. This initial analysis is crucial to plan the intervention and avoid touching pathological areas unnecessarily.
Surgical procedure
- Preparation and First Steps: Dr. Felippu starts the procedure by pushing the polyps towards the back with cotton. The objective is to identify the frontal process of the maxilla, where the initial incision will be made.
- Uncinectomy and Access to the Maxillary Sinus: A uncinectomy is performed to access the maxillary sinus. The process includes the identification of the lacrimal bone and the main ostium of the left maxillary sinus.
- Section and Anatomical References: Using scissors, a cut is made parallel to the lamina papyracea, maintaining key anatomical references such as the infraorbital nerve of V2 and the orbit.
- Change of Optics and Exploration of the Frontal and Sphenoid Sinuses: The optics are changed to a thirty degree angle to examine the left frontal sinus, removing secretions to obtain a clear view. The optics are then directed downward to explore the left sphenoid sinus.
- Elimination of Pathology: The pathology is removed en bloc, providing a final view of the left side that includes the sphenoid and maxilla.
- Intervention on the Right Side: The same steps are repeated on the right side, with particular attention to the frontal process of the maxilla and the dissection of the maxillary sinus.
- Fracture and Lavage of the Sphenoid Sinus: With the help of a chisel and osteotome, the sphenoid sinus is fractured and cleaned.
- Arterial Ligation: Arterial ligation is routinely performed for hemostasis and selective parasympathectomy, significantly improving postoperative outcome.
Postoperative and Follow-up
The video concludes with a follow-up endoscopy three months after surgery. A satisfactory recovery is observed with a detailed review of the maxillary, sphenoid and frontal sinuses on both sides. Dr. Felippu emphasizes the importance of adequate clinical support to ensure successful long-term results.
