The alternative needle handling technique in endoscopic surgery

OBJECTIVE: To introduce and evaluate an alternative needle handling technique for endoscopic endonasal suturing that does not require specialized instruments. METHODS: This retrospective study included patients who underwent endoscopic surgery at two institutions between October 2025 and March 2026. We analyzed cases in which the same surgeon performed suturing of the anterolateral nasal cavity using both conventional and alternative techniques. Needle handling time, defined as the interval from needle insertion to withdrawal, was assessed using surgical videos and medical records. The procedures were performed by two board-certified otolaryngologists and two junior surgeons. RESULTS: Sixty-one cases involving 115 procedures were analyzed in this study. With the conventional technique, the needle handling time was significantly longer on the left side than on the right, and junior surgeons required significantly more time than board-certified surgeons. Using the alternative technique, board-certified surgeons remained faster; however, no significant laterality-related differences were observed. Relative to the conventional technique, the alternative method significantly reduced the needle handling time on both sides, with a greater reduction observed on the left side and among junior surgeons. CONCLUSION: The alternative needle handling technique may reduce suturing time, regardless of surgical experience. This method is particularly useful for suturing the anterolateral nasal cavity and can be widely implemented without the need for specialized instruments.