Modified Endoscopic Diving Technique without the Traditional Irrigation System in Endoscopic Cranial Base Surgery: Technical Note

Background: We describe a modified endoscopic diving technique with an alternative irrigation system different than the one used by Locatelli et al. (CLEARVISION II, Karl Storz and Co., Tuttlingen, Germany). Methods: From January 2016 to October 2018, our senior surgeon performed the modified endoscopic diving technique in 76 endoscopic surgical procedures. Diving surgery was performed in all procedures to check the completeness of tumor resection, thus allowing for the removal of any residual tumor tissue. Results: In the modified endoscopic diving technique, the optic system and the irrigation source are separated into 2 independent tools, allowing surgeons to point the flow on a selected structure, whereas the endoscope can be pointed in the same direction or not. Moreover, the optic system and the irrigation source can be placed at different distances. Surgeons can control the infusion pressure and the entity of the flow. Conclusions: The use of the modified endoscopic diving technique allows surgeons to have more settings that could be controlled and also bypasses any compatibility issues between different endoscopic systems. In addition, the reproducibility of this technique, together with the low cost of the instrumentation, could allow an easier application of the diving technique.