8.2. Equipment and Instruments
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In my practice, I use the following equipment and instruments for BESS/UBE decompression of lumbar foraminal stenosis. Independent viewing and working portals allow endoscopic visualization to be combined with conventional spinal instruments.
Equipment
1. A radiolucent operating table with a Wilson frame.
2. A C-arm.
3. An endoscopy tower: monitor; video system — console and camera; light source and light cable; 0° scope; 30° scope (optional).
4. A gravity irrigation system without a pump: two 3 L bags of normal saline. I maintain continuous free outflow through the working portal. For details, see §2.4, Irrigation and Fluid Outflow.
5. A Stryker CORE 2 system with a powered instrument handpiece: 5 mm cutting burr; Tomcat, Aggressive Plus, and other shaver tips. I select tips according to their compatibility with the specific system.
6. A BONSS ARS600 radiofrequency generator: an RF electrode with a 5 mm working tip; an RF electrode with a 1.5 mm working tip (optional). Operating settings and application rules are provided in §2.6, Hemostasis.
7. A suction system and an irrigation fluid collection system.
Instruments
1. A specialized BESS/UBE instrument set.
2. A dilator set.
3. Kerrison rongeurs: 3 mm and 2 mm working widths; 45° angle.
4. Disc rongeurs: straight and upturned.
5. A nerve root retractor.
6. An elevator.
7. An endoscopic annulotomy knife (Indian knife).
8. Osteotomes (chisels): straight; right and left hockey-stick types; curved at 30°.
9. A mallet.
Preoperative Checks
Before surgery, I check component compatibility and the condition of cables, connections, the pedal, and the suction system. I separately check the saline supply and the ability to maintain free outflow. When using the C-arm, we use radiation protection equipment and individual dosimeters.
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.
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