Endoscopic HNP operation
(HNP=hernia nuclei pulposi=protruding intervertebral disc)
Operations for hernia traditionally are performed through an incision of 8-12cm, necessary to reach the intervertebral disc. Below an example of a minimal invasive technique is described where the same result is obtained through an endoscope (incision of 1,5cm).
1
2
3
4
5
6
The patient lies in knee/elbow position (salaam, photograph 1). A roentgen apparatus with monitor (2,3) is necessary for positioning the workingcanal. After sterile cover of the patient (4) the intervention can start with the specialized instruments (5,6,7).
7
8
9
10
11
On diagram (8,9,10.11) is seen that with a number of in diameter incurring tubes the access to the intervertebral space is obtained.
12
13
14
15
16
Here, in 12-16, the same is seen in reality. By sliding in larger tubes around one another more space in the tissue arises and eventually the workingcanal for the endoscope can be placed under roentgen control.
17
18
19
20
21
22
Fixation of the workingcanal takes place to an arm (17) fixed to the operation table and hereafter the endoscope is placed in the workingcanal(18-20). In the workingcanal is also room for special instruments to take away the protruding cartilage (21-23)
23
24
25
26
27
The surgeon and the assistants follow the progress of the intervention by means of monitors on both sides of the patient (24-29). At the end a small wound remains after removal of the instrument (30,31).
28
29
30
31
32