The Hand Lothrop: A Zero-Degree Endoscopic Draf III Procedure with a Kerrison Rongeur

Powered instruments such as drills are commonly used in the endoscopic modified Lothrop procedure, also known as Draf III frontal sinusotomy. However, the use of drills may be associated with increased bone exposure, prolonged postoperative healing, synechiae and crust formation, and mechanical injury to the nasal vestibule. The objective of this study is to present a simple alternative method for manually performing the endoscopic modified Lothrop procedure using a Kerrison rongeur and a 0-degree endoscope. A surgical candidate for an endoscopic modified Lothrop procedure was identified, and informed consent was obtained to record surgical footage to illustrate the technique. This article describes an alternative technique for performing the endoscopic modified Lothrop procedure using manual instruments, thereby avoiding the use of powered drills and potentially allowing for maximal preservation of the frontal recess mucosa. In addition, the technique enables the procedure to be performed without the use of angled endoscopes, facilitating surgical maneuvers. A summary table outlining each step of the procedure with technical tips, as well as a surgical video illustrating the technique, are also presented. This manual Draf III frontal sinusotomy technique may complement the surgical armamentarium of the frontal sinus surgeon.