4.2. Equipment and instruments
@ProfFishchenkoIn my practice, I use the equipment and instruments listed below to remove intracanal lumbar disc herniations with BESS/UBE. Independent viewing and working portals allow endoscopic visualization to be combined with familiar spinal instruments.
Equipment
- Radiolucent operating table with a Wilson frame.
- C-arm.
- Endoscopy tower: monitor; video system — console and camera; 0° endoscope; 30° endoscope (optional); light source and light cable.
- Gravity irrigation system without a pump: two 3 l bags of saline. I maintain continuous free outflow through the working portal. Fluid delivery and outflow control are described in §2.4, “Irrigation and maintaining fluid outflow”.
- Stryker CORE 2 system with a powered instrument handpiece: 5 mm cutting burr; Tomcat, Aggressive Plus, and other shaver blades. I select attachments according to compatibility with the specific system.
- BONSS ARS600 radiofrequency generator: RF electrode with a 5 mm working tip; RF electrode with a 1.5 mm working tip (optional). Operating settings and instructions for use are provided in §2.6, “Hemostasis”.
- Suction system and irrigation fluid collection system.
Instruments
- Specialized BESS/UBE instrument set (optional).
- Dilator set.
- Kerrison punches: working tip width 3 mm; angle 45°.
- Reverse Kerrison punches; angle 90°.
- Discotome.
- Nerve root retractor.
- Elevator.
- Endoscopic annulotomy knife (Indian knife).
- Osteotome (chisel; optional).
- Mallet.
Preoperative check
Before surgery, I check component compatibility and the condition of cables, connections, the pedal, and the suction system. I separately check fluid delivery and the ability to maintain free outflow. We use radiation protection equipment and personal dosimeters when working with the C-arm.
Photographs of equipment and instruments
Photographs and a detailed description of the standard set are provided in the general section of the atlas:
- §1.2. Instruments for biportal endoscopic spine surgery.
- §1.3. Equipment for biportal endoscopic spine surgery.
References
1. Park DK, Weng C, Zakko P, Choi DJ. Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation. JBJS Essent Surg Tech. 2023;13(2):e22.00020. doi:10.2106/JBJS.ST.22.00020.
2. Choi CM, Chung JT, Lee SJ, Choi DJ. How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis. Acta Neurochir (Wien). 2016;158(3):459–463. doi:10.1007/s00701-015-2670-7.
3. Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J. 2013;22(5):1037–1044. doi:10.1007/s00586-013-2701-0.
Previous section: 4.1. Indications and contraindications