Endonasal laser-assisted dacryocystorhinostomy

Abstract

Dacryocystorhinostomy is a procedure that is performed to allow drainage of tears from the lacrimal sac directly into the nasal cavity. Endonasal telescopes facilitate performance of this operation with better visualization and decreased morbidity. We present our experience with endoscopic laser-assisted DCR. In the last 31 months, we have performed 31 procedures on 23 patients with either the holmium:YAG laser or the argon:HGM laser. We have a 97% overall success rate with a mean follow-up of 16 months. Our series includes both adult and pediatric patients as well as five revision procedures after failed external DCR. We present our technique, results, and the reasons for our change in laser delivery systems. Most importantly, we discuss the technical factors that contribute to our overall success. These include a large rhinostomy size, simultaneous correction of intranasal and/or sinus pathology, the avoidance of laser use within the lacrimal sac, and close postoperative monitoring with intranasal debridement. We conclude that endoscopic laser-assisted DCR is a better alternative to standard external DCR because it avoids a cutaneous scar, excessive tissue injury, and postoperative morbidity.