5.2. Equipment and Instruments

Contents

In my practice, I use the equipment and instruments listed below to remove foraminal and extraforaminal lumbar disc herniations using BESS/UBE. Independent viewing and working portals allow endoscopic visualization to be combined with conventional spinal instruments.

Equipment

1. Radiolucent operating table with a Wilson frame.
2. C-arm.
3. Endoscopic tower: monitor; video system—console and camera; 0° endoscope; 30° endoscope (optional); light source and light cable.
4. Gravity-fed irrigation system without a pump: two 3 L saline bags. I maintain continuous free outflow through the working portal. Fluid delivery and outflow control are described in §2.4 “Irrigation and Establishing Fluid Outflow”.
5. Stryker CORE 2 system with a powered instrument handpiece: 5 mm cutting burr (spherical or barrel-shaped); Tomcat, Aggressive Plus, and other shaver blades. I select attachments according to compatibility with the specific system.
6. BONSS ARS600 radiofrequency generator: RF electrode with a 5 mm working tip; RF electrode with a 1.5 mm working tip (optional). Working settings and instructions for use are given in §2.6 “Hemostasis”.
7. Suction system and irrigation fluid collection system.

Instruments

1. Specialized BESS/UBE instrument set (optional).
2. Dilator set.
3. Kerrison punches: working tip widths of 2 and 3 mm; 45° angle.
4. Straight discotome.
5. Up-angled discotome.
6. Nerve root retractor.
7. Elevator.
8. Endoscopic annulotomy knife (Indian knife).
9. Straight osteotome (chisel).
10. Right hockey-stick osteotome.
11. Left hockey-stick osteotome.
12. Osteotome angled at 30°.
13. Mallet.

Preoperative checks

Before surgery, I check component compatibility and the function of cables, connections, the foot pedal, and the suction system. I separately check fluid inflow and the availability of free outflow. When working with the C-arm, we use radiation protection and personal dosimeters.

Photographs of equipment and instruments

Photographs and a detailed description of the standard set are provided in the general part of the atlas:

§1.2. Instruments for Biportal Endoscopic Spine Surgery.

§1.3. Equipment for Biportal Endoscopic Spine Surgery.

References

1. Choi DJ, Kim JE, Jung JT, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J. 2018;12(3):569–573. doi:10.4184/asj.2018.12.3.569.

2. Ahn JS, Lee HJ, Choi DJ, Lee KY, Hwang SJ. Extraforaminal approach of biportal endoscopic spinal surgery: a new endoscopic technique for transforaminal decompression and discectomy. J Neurosurg Spine. 2018;28(5):492–498. doi:10.3171/2017.8.SPINE17771.

3. Park JH, Jung JT, Lee SJ. How I do it: L5/S1 foraminal stenosis and far-lateral lumbar disc herniation with unilateral bi-portal endoscopy. Acta Neurochir (Wien). 2018;160(10):1899–1903. doi:10.1007/s00701-018-3630-9.

Previous section: 5.1. Indications and Contraindications

Next section: 5.3. Portal Planning and Marking for a Left-sided Approach

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