9TH ENDOKL 2020 World Congress for ENDOSCOPIC SURGERY OF THE PARANASAL SINUSES SKULL BASE BRAIN AND SPINE 15TH- 18TH July 2020 Sangri-La Hotel Kuala Lumpur Malaysia- More Details

Ahilasamy’s Diathermy Round Knife for Endoscopic Ear Surgery
Introduction:

As a surgeon practicing minimally invasive earsurgery, I felt the need first to identify a new instrument that could perform a certain function in a better way. The need in turn can generate the idea or concept which may then lead to the design and development of a new instrument. If that instrument provides features that facilitate or advance the art of surgery and, at the same time, provides an opportunity to the instrument companies to realize a financial gain, then it may gain the attention of the practicing surgeons and deserve the interest of the surgical companies. This Diathermy round knife designed by me is one such.


The Need and Idea

I started doing endoscopic ear surgeries approximately 12 years ago. The frustration generated by the difficulty in elevating tympanomeatal flap by single hand due to bleeding from incision area forced the idea for the development of this cautery knife instrument that could do the job safer, faster and more efficiently. Both hemostatically and elevating the flap with the same instrument without frequent suction.

The French and Italian surgeons use monopolar diathermy for making incision for tympanomeatalflap for the past several years without any healing complications. Mine is a modification of Rosen’s round knife but insulated with port at the back for attachment of monopolar cable. I use low power at 10 in diathermy machine to make ear canal incision. Use suction to suck fume. With the same instrument elevate the tympanomeatal flap. Absolutely bloodless elevation of tympanomeatal with single hand without need for suctioning.

Whenever I had bleeding and difficulty in tympanomeatal flap endoscopically, I kept saying to myself over and over again, “There has to be a better way.” The need for this instrument had made its presence known to me in a very clear and convincing way. I am using it for the past 1 year without any problem in healing which is the concern for many. I have demonstrated thrice in live ear surgery in India and abroad.

This new instrument which I called “The game changer in endoscopic ear surgery.” The development of my diathermy round knife will prevent many migrating to two handed cumbersome ear surgery using various unsuccessful endo holders. (Figure 1,2,3). The French and Italian surgeons use monopolar diathermy for making incision for tympanomeatalflap for the past several years without any healing complications. Mine is a modification of Rosen’s round knife but insulated with port at the back for attachment of monopolar cable. I use low power at 10 in diathermy machine to make ear canal incision. Use suction to suck fume. With the same instrument elevate the tympanomeatal flap. Absolutely bloodless elevation of tympanomeatal with single hand without need for suctioning.


Summary

The Endoscopic Ear surgeon is generally the first to identify the need for a new device, instrument or technique due to the difficulties he faces day to day in the OT. Identifying the need can lead to the concept of a new instrument or device. In turn, designing, patenting and developing this Ahilasamy’s round diathermy knife may facilitate the performance of surgery and advance the art of Endoscopic surgery to a higher level.

Watch the video to see the instrument in use