Applications and Outcomes of Orbital and Transorbital Endoscopic Surgery

Objective. To prospectively evaluate the safety, effectiveness, and utility of orbital and transorbital endoscopic surgery. Study Design. Case series with planned data collection. Setting. Level 1 trauma center and tertiary academic hospital. Subjects and Methods. Consecutive sample of 107 patients undergoing orbital or transorbital endoscopic operations. Main Outcome Measures. Ability to achieve intraoperative goals using endoscopic approach; occurrence of predetermined intraoperative or postoperative complications. Results. One hundred seven patients (aged 6-83 years) underwent orbital or transorbital endoscopic surgery for 6 different indications. Seven incisions were used. Endoscopic orbitotomies were made through all 4 orbital walls to access surrounding structures. Intraoperative goals were achieved endoscopically in 106 patients. Mean follow-up was 3 months (mean +/- SD, 3.0 +/- 3.5). No complication was directly related to surgical approach or use of endoscopy. Seventeen complications were detected in 2 categories: persistent diplopia and persistent vision change. No patient had vision loss. No nonfracture patient suffered a complication. Subgroup analysis demonstrated no difference in surgical success rates when compared with transnasal and transantral medial orbital wall and orbital floor repair and cerebrospinal fluid leak repair. Endoscopic visualization was advantageous in several respects: superior visualization and lighting, particularly posterior to the equator of the globe; image magnification; and video monitoring for education and operating room staff involvement. It also facilitated surgical navigation and computer-aided reconstruction. Conclusion. Orbital and transorbital endoscopy are versatile, effective, and safe approaches useful for addressing diverse urgent and elective problems. In appropriate clinical situations, these procedures may offer better access and visualization than open or transnasal approaches.