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Shaikh et al. Mini-invasive Surg 2020;4:89 I http://dx.doi.org/10.20517/2574-1225.2020.97 Page 7 of 19

Figure 6. A: Lotta scope with ceramic bipolar; B: optical obturator for guided insertion

Endoscopic accessories
Irrigating sheaths for endonasal procedures
To improve visibility further and to tackle issues such as fogging in a better manner, lens cleaning devices
[42]
and irrigating sheaths [Figure 7] were introduced by Cappabianca et al. . Although it may be extremely
useful for better uninterrupted vision, especially without a good assistant, the increased outer diameter
of the scope shaft with the sheath does not allow ease of instrumentation. We have favored dynamic
endoscopy with manual irrigation. However, there are strong proponents of its use, e.g., Prof. Locatelli et
[43]
al. with the forceful irrigation method called “diving technique”. This not only improves irrigation but
also washes away debris forcefully and helps in developing better tissue planes by hydrodissection (waterjet
method).

Endoscope holders
Endoscope holders add to the comfort and ease of the surgeon in endoscopy and help to free the operating
hands [Figure 8]. The three types of holders available are rigid non-pneumatic (Aesculap), semi-rigid (Karl
[12]
Storz), and pneumatic holders (Mitaka, USA) . The endoscope holders restrict your field of view and may
be used for a small focused area of surgery, viz. ETV. However, the dynamic endoscope movement allows
almost 3D visualization in endonasal approach, and hence holders are not preferred in that surgery. The