Wrapping method for better fat handling in endoscopic trans-sphenoidal surgery

Background: Fat is commonly used for preventing cerebrospinal fluid (CSF) leakage during endoscopic transsphenoidal surgery (ETSS). However, fat is soft, slippery, and sometimes not easy to handle. The present study aimed to examine the efficacy of our Surgicel^® wrapping method, which allows for better fat handling, in preventing the occurrence of CSF leakage among patients undergoing ETSS.

Methods: We used fat tissues removed from the abdomen. The fat was cut with scissors into pieces that were approximately 5 mm in size. Surgicel^® was also cut into 2.5 cm². The fat tissues were encased with these Surgicel^® squares and slightly moistened with a saline solution.

Results: Between January 2023 and August 2024, 34 patients aged 18-86 years (average 54.9 years) underwent ETSS. Among these patients, 20 had pituitary tumors, 6 had Rathke's cysts, and 8 had other conditions. None of the patients had CSF leakage postoperatively. The use of Surgicel^®-wrapped fat during ETSS is better than the use of fat alone.

Conclusion: The Surgicel^® wrapping method allows for better fat handling during ETSS.