E-ISSN: 1019-5157
ISSN: 2651-5024
Technical Note
Improving Irrigation Outflow in Unilateral Biportal Endoscopic Spine Surgery: A Practical Bitubular Modification
Gardashkhan KARIMZADA✉ ,
Patil Mandar Pradip ,
Demet Evleksiz ,
Mehmet Ilker Ozer ,
Ilker Solmaz ,
Cheol Wung Park
Department of Neurosurgery, Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi; Neurosurgery, All India institute of medical sciences, Bhubaneswar, India; Neurosurgery, Çorum Erol Olçok Training and Research Hospital; Neurosurgery, Sincan Research and Training Hospital, Department of Neurosurgery, Ankara, Türkiye; Neurosurgery, Private Practice; Neurosurgery, Daejeon Woori Hospital, Department of Spine Surgery, Daejeon, South Korea.
Accepted: 14/08/2026
Article in Press
Corresponding Author:
Gardashkhan KARIMZADA (kerim_zade@outlook.com)
Abstract
IAim: To describe a practical modification in unilateral biportal endoscopic spine surgery (UBESS) to ensure continuous fluid outflow.
Materials and Methods: Two specially modified tubular retractors were placed at the working and viewing ports, facilitating unidirectional outflow while preserving the principles of biportal endoscopic surgery. A single case illustrating the use of this technique has been described.
Results:
The use of tubular retractors enhanced fluid outflow. Visual clarity was maintained during soft tissue coagulation and bone drilling—procedures in which visual clarity is most frequently compromised in the standard approach. No postoperative tissue swelling due to fluid accumulation under the skin or within the muscle was observed. Furthermore, the special design of the tubular retractors precludes the requirement of a third hand for root retraction, and the simplicity of this technique enhances its reproducibility.
Conclusion: The bitubular approach ensures unobstructed outflow during UBESS. Additionally, the modified viewing retractor facilitates root retraction, and surgeon maneuverability is simplified by the nonreliance on a third hand for root retraction. Large-scale studies with a high case volume are needed to evaluate the routine applicability, safety, and effects of the bitubular technique on tissues.
Materials and Methods: Two specially modified tubular retractors were placed at the working and viewing ports, facilitating unidirectional outflow while preserving the principles of biportal endoscopic surgery. A single case illustrating the use of this technique has been described.
Results:
The use of tubular retractors enhanced fluid outflow. Visual clarity was maintained during soft tissue coagulation and bone drilling—procedures in which visual clarity is most frequently compromised in the standard approach. No postoperative tissue swelling due to fluid accumulation under the skin or within the muscle was observed. Furthermore, the special design of the tubular retractors precludes the requirement of a third hand for root retraction, and the simplicity of this technique enhances its reproducibility.
Conclusion: The bitubular approach ensures unobstructed outflow during UBESS. Additionally, the modified viewing retractor facilitates root retraction, and surgeon maneuverability is simplified by the nonreliance on a third hand for root retraction. Large-scale studies with a high case volume are needed to evaluate the routine applicability, safety, and effects of the bitubular technique on tissues.
Keywords
biportal endoscopic surgery
irrigation
tubular retraction
outflow