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A Step-by-Step Guide Through Sinus Surgery

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A Step-by-Step Guide Through Sinus Surgery

Jun 23, 2023

If you are scheduled for endoscopic sinus surgery, you may be curious about how the surgeon clears your sinuses. Sinus specialist Richard Orlandi, MD, offers a play-by-play of the surgery. If you or someone you know is considering sinus surgery, listen to other episodes with Dr. Orlandi about how sinus surgery can help you, surgery preparation, post-surgery recovery, and facts about sinus surgery. Click here to make an appointment to see if sinus surgery is right for you.

Interviewer: You've chosen to get sinus surgery, sometimes referred to as endoscopic surgery. And now your day is here and you're wondering what the procedure is going to be like, even though you are probably not going to remember much of it. That's what we are going to talk about next on The Scope.

So when it comes to time to get your sinus surgery, what exactly is going to be going on? A lot of you are probably not even going to know what is going on, but you might be curious nonetheless.

We are talking to Dr. Richard Orlandi, he's one of the experts at University of Utah Health Care on this type of procedure. So what I'd like to do is go step-through-step in this procedure. This is the play-by-play from leaving the waiting room to entering the recovery room. So let's go ahead and go. I'm in the waiting room, and somebody comes out and says, "Interviewer, it's time for your surgery."

Dr. Orlandi: And you're so excited at that point.

Interviewer: Yes because as you said people can really suffer from this condition. It can really change your life.

Dr. Orlandi: You're going to feel better, this is the first step.

Interviewer: All right. Good.

Sinus Surgery: From the Waiting Room to the Operating Room

Dr. Orlandi: So they're going to take you back to a room where you're going to put one of those really fancy gowns on and beyond that, you're going to do standard things for surgery. You're going to get an IV, the anesthesiologist is going to visit with you, the surgeon will come to visit with you, make sure you have no last-minute questions, your family members. And then very often you'll get a little bit of sedation and at this point, this is where you typically stop remembering things.

Interviewer: Yeah, okay.

Anesthesia and Sedation

Dr. Orlandi: And they'll wheel you into the operating room. In the operating, obviously, we'll position you on the operating room table, and the anesthesiologist will put you to sleep. And from that point on what we are typically doing is getting the nose ready for the sinus surgery. We want to control the bleeding. Anyone who has had a nosebleed, which is all of us, knows that the nose can actually really bleed.

Controlling Bleeding

So a lot of the things that we are doing at the beginning of the procedure are targeted at decreasing the blood flow into the nose. We use medications like Afrin or Dristan, which shrink down the blood vessels. We also use some injected medication while you are asleep, near blood vessels to cause those blood vessels to shrink down so we don't get as much bleeding during the surgery.

Interviewer: All right, so you are controlling bleeding. What are some of the other things you're doing before you actually go in and do the procedure?

Equipment and Imaging

Dr. Orlandi: So, obviously getting all the equipment ready and we've got wonderful staff that take care of that. An operating room is really a team sport so everyone is doing their different jobs. Once we ensure the equipment is all ready, and the patient is asleep, we verify what we are doing and make sure all the safety measures are in place. And we've gone ahead and gotten the blood flow to the nose slowed down. Then what we're going to do is look inside the nose, and verify everything with our imaging studies. We usually have everything, well, we always have our cat scans in our operating room and verify our plan. Then we start.

Interviewer: And what does this device look like, that actually does the work? The endoscopic device? What's it called?

Dr. Orlandi: It's a really good question. So the endoscope, or the nasal telescope, it's a fiber optic-type scope, that we're looking through. We're typically projecting that through a high-definition camera onto a large screen where we can actually see the images magnified inside the nose. That thing is about the size of a pencil. So that goes in the nose. Then there is a variety of equipment that goes alongside that to help open the sinuses and do the work that we need to do.

It's a little bit like going to the dentist's office and they've got that whole tray of instrumentation that is going to do all the mean things they do to your teeth. Well, we're going to do the same sort of mean things to your nose with you asleep and we have probably about 50 or 60 pieces of equipment that will cut in different shapes and different angles and so forth, to get those sinuses open.

Precise and Targeted Surgery

But one of the devices that we use actually will bring tissue into the shaft of an instrument and cut it off like a little spinning guillotine at the end. I don't know how to better describe it. Sounds kind of scary but that helps get rid of polyps and things like that, that are growing inside the nose, excess tissue that we want to get rid of.

Interviewer: So the old way of doing this, before the endoscopic way. You had to make cuts, but it is completely noninvasive.

Dr. Orlandi: Yeah, well this is evasive in that we are cutting, but it's not invasive that we, it's very targeted. It's not microscopic, but it's almost microscopic because the image that we see is so magnified. So the surgery that we do is very precise, very targeted and we really leave the rest of the nose and sinuses alone that don't need anything done so that there is no trauma there and less opportunity for scaring.

Interviewer: Does it just amaze you every time you do this procedure that you're able to do this procedure? It's amazing to me.

Dr. Orlandi: I guess you get used to it after a few years, right? But it's pretty cool what we're able to do in such a targeted and really minimally invasive way.

Post-Surgery Care: Home Discharge and Anesthetic Effects

Interviewer: Yeah, all right. So the procedure has been done. Sounds like you planned out how you wanted to open things up and you've opened things up. What do you do at that point?

Dr. Orlandi: So once we finish what we set out to do, we'll make sure that the bleeding again is under control and then we'll wake the patient up. Some surgeons will place a dissolvable packing in the nose to try to control the bleeding and use pressure. Others of us will put material in the nose that will decrease the bleeding and then remove that right after the patient has woken up in the operating room so that the patient leaves the room without any packing in their nose.

Interviewer: So I'm aware now that I'm leaving the operating room?

Dr. Orlandi: Unfortunately, you're probably not going to become aware for another hour because of the anesthetic that you've gotten. But patients, we take into the recovery room, they'll recover there under the care of our great nurses and then they'll go into a second stage and begin to remember at that point. That's usually when a family member will join them.

Time to Go Home

Interviewer: How much time elapses after you're taken out of the OR that you're kind of conscious again?

Dr. Orlandi: Usually it varies, but it's probably about 45 minutes, on average.

Interviewer: Okay. And at that point am I able to go home?

Dr. Orlandi: Usually, we have you spend another half hour to 45 minutes with us, just having something little to eat. Make sure you are okay and the anesthetics are worn off. And at that point when you are safe to go you'll be taken home by a family member or a loved one.

Interviewer: So after the surgery is done and I'm back home the same day, in many cases do I need to have somebody there with me at that point through the night?

Have Someone Stay With You

Dr. Orlandi: Because it has been general anesthesia and you've been completely asleep, that anesthesia effect is going to last about 24 hours. It would be wise to have someone at home with you during that time.

Interviewer: What about other aspects of the recovery, can they assist in that or are those things that I can do?

Dr. Orlandi: Those are things that you can pretty much do, but just to have someone there to help you not make bad decisions is always a good idea.

Interviewer: Fascinating procedure and the recovery begins. Any final thoughts?

Dr. Orlandi: So it's important to remember surgery is really scary and this particular surgery has been around now for roughly 30 years. We've been doing it for many, many years and feel comfortable with it. And you're really going to be taken care of by a room full of experts, with nursing and anesthesia and your surgeon. And I hope this information has been helpful to people to help deal with that anxiety. And of course, if you ever have any questions, make sure you ask your surgeon and get all the answers to your questions. Make sure all your concerns are addressed before you undertake the surgery.

updated: June 23, 2023
originally published: February 3, 2015