Literature Review: A Roundup of Important Recent Studies

• Newer Surgical Procedures Not Necessarily Better
• Primary Frontal Sinus Endoscopic Surgery Relieves Frontal Sinus Symptoms in Most
• Success Following Surgery to Correct Obstructive Sleep Apnea Dependent Upon Scoring Measures
• Intranasal Splint Use after Surgery Increases Patient Pain, Provides Few Offsetting Benefits
• New Reprocessing Guidelines for ENT Endoscopes Stress High-Level Disinfection Techniques
• Multicenter Study Shows Feasibility and Safety of Transoral Robotic Surgery

Newer Surgical Procedures Not Necessarily Better

How far should we as surgeons develop procedures that may be more costly—and perhaps more dangerous—than those we already have available?

Background: We, as surgeons, often manipulate, change adapt, and revise surgical procedures we perform in otolaryngology-head and neck surgery for the patient’s benefit. However, there are recent instances in which some procedures that have been developed are costly, take longer and present a high risk of complications in the name of cosmesis.

Study design: Guest editorial.

Setting: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital, Ohio State University Medical Center, Columbus.

Synopsis: Recently, highly respected journals have published articles describing endoscopic surgery for the thyroid via the axilla and the removal of benign neck masses in children using an endoscopic axillo-breast approach. These articles describe procedures with increased operative time, risks, complications and cost compared with standard approaches to the thyroid or neck mass biopsy. With health care often considred to be too costly, it is unclear how procedures such as these will be supported in today’s health care world and in the future. The question is, are these procedures developed in the same way as endoscopic skull base surgery and pituitary surgery, procedures that have completely changed health care for the better in terms of cost, safety, recovery and outcomes?

Bottom line: Perhaps we need to rethink some surgical developments that are more costly, less safe and more prone to complication—especially in cases where standard surgeries have stood the test of time. Meanwhile, it is hoped that surgeons using these procedures to treat patients describe to patients all factors involved, including cost, safety issues and the increased risk of complications.

Reference: Schuller DE. Why are more costly and more dangerous surgical procedures being developed? Arch Otolaryngol Head Neck Surg. 2012;138(6):539-540.

—Reviewed by James A. Stankiewicz, MD

Primary Frontal Sinus Endoscopic Surgery Relieves Frontal Sinus Symptoms in Most

Over the long term, what factors are most important for successful frontal sinus surgery?

Background: Unfortunately, primary frontal endoscopic sinus surgery is not always successful, especially over the long term. Frontal sinus stenosis, a risk of surgery, can result in recurrence of symptoms. It is important to look at the factors responsible for success and failure to help improve outcomes.