Endoscopic Dacryocystorhinostomy with a Piezoelectric System: How We Do It

Endoscopic dacryocystorhinostomy (DCR) is a widely recognized and highly effective procedure. This surgical procedure is performed globally, with minimal modifications across different regions. Background/Objectives: The fundamental goal of DCR is to marsupialize the lacrimal sac into the nasal cavity, which helps eliminate epiphora (excessive tearing) and recurrent dacryocystitis (inflammation of the tear sac). With advancements in technology, new instruments are being developed to minimize risks and maximize efficacy, ultimately improving surgeon convenience, patient safety, and quality of life. One such innovation is piezosurgery, a method of bone cutting that utilizes ultrasound vibrations. Originally prevalent in oral and maxillofacial surgery, piezosurgery is now being applied in many clinical applications. Its primary advantages include the preservation of soft tissues, precise bone cutting, and the ability to work effectively in narrow spaces. Methods: This article outlines the standard technique used at our facility for performing endoscopic dacryocystorhinostomy (DCR) with a piezoelectric system. We describe the preoperative evaluation, intraoperative techniques, and postoperative care to present what we consider the standard procedure in our clinic. Results and Conclusions: Piezosurgery’s selective cutting prevents damage to surrounding soft tissues, making it theoretically advantageous in DCR by preserving tissue integrity. Additional case–control and multicenter studies are necessary to compare its outcomes with those of traditional osteotomy, particularly in relation to the potential increase in operative time.