How I Control Bleeding
Endoscopically
The best way to control bleeding is to move around the cannula until you find that sweet spot, because just moving the cannula sometimes will change the fluid dynamics and the hydrostatic pressure which gets it to stop bleeding.
If that doesn’t work, then I’ll try to find the bleeder and coagulate it… I’ll usually have to increase the irrigation pressure for that but I do that in a limited way.
Worst case scenario is to take everything out and you fill this area with SurgiFlow, and you wait three minutes, and then you go back in there, look for the bleeder.
Yes, once it starts bleeding, it can be difficult. So I don’t want the bleeding to start in the first place, it can slow the surgery down. I don’t think I’ve ever had to resort to open surgery because of a bleeding problem, I just take my time until I find a position that gets the bleeding under control.
For All You Laser Haters
Who say it’s too dangerous…
Anything can be dangerous if you use it on the wrong structure. Like a scalpel is dangerous when used incorrectly. What I love about the laser is how precise it is. The red aiming light shows exactly where it’s ablating, and the laser has a very low depth of penetration so the energy stays right where I put it.
It’s also non-electrical. If I’m working right next to a nerve, I’m not electrically shocking the nerve like I potentially can with some other instruments.
Laser Safety Demonstrated
The laser works really well on pathologic tissue, while not harming normal tissue. In this video, I use the laser on normal annulus as well as pathologic tissue, and you can see the difference.
That combination of precision, safety, and effectiveness is why I love having the laser as one of the tools in my toolbox. If the patient were me or my beloved family member, it’s a no-brainer!!
Latest Surgery Video
57-Year-Old Golfer | Annular Tears Treated With LESS
A 57-year-old golfer had been living with disabling low back pain for months, radiating into his right groin, thigh, and calf, with no lasting relief from nonoperative treatments. Diagnostic injections let me pinpoint the true source: annular tears at two adjacent lumbar levels. Using an endoscopic approach, I was able to directly visualize and remove the torn, inflamed disc tissue at both levels in the same procedure, while keeping the surrounding healthy structures untouched.
What you’ll see in this video:
- Diagnostic injections confirmed the annular tear before surgery
- Annular tears identified at two adjacent lumbar levels
- Empty tent sign and adhesions found during endoscopic access
- Torn disc tissue removed at the first level
- A complex tear with inflammation found at the second level
- Dural tube visualized intact and pulsating throughout