The first article, titled “Full-endoscopic spine surgery diminishes surgical site infections – a propensity score-matched analysis, focuses on the significantly reduced risk of surgical site infections (SSI) associated with FESS. SSI is one of the most frequent and costly complications following spinal surgery. In this research, a multicenter cohort study has been performed by a group of spine surgeons, including Mark A. Mahan, Tobias Prasse, Robert B. Kim, Sananthan Sivakanthan, Katherine A. Kelly, Osama N. Kashlan, Jan Bredow, Peer Eysel, Ralf Wagner, Albert E. Telfeian and Christoph Hofstetter, to examine the rate of SSIs in patients undergoing FESS and compare it to a matched cohort from the National Surgical Quality Improvement Program (NSQIP) database (database (see figure below for illustration).

1277 non-instrumented FESS cases between 2015 and 2021 were collected for analysis, while data of 55,882 patients was selected for the nonendoscopic NSQIP cohort. The results revealed that the SSI rate in endoscopic patients was significantly lower than in non-endoscopic patients (a 16-fold risk reduction), underscoring the superiority of FESS over traditional procedures.

Several factors likely contribute to the low infection rate in full-endoscopic surgeries,

1. The volume of tissue disruption is limited when performing FESS. Minimizing tissue trauma by
   reducing the extent of the surgical cavity is known to alleviate the risk for SSI in other surgical
   fields;
2. Continuous irrigation of the surgical field with saline is a standardized part of FESS to
   maintain clear vision and it might effectively lead to the distinct reduction of SSI by preventing
   significant bacterial colonization. Notably, the surgeons in the FESS cohort did not utilize
   antibiotic irrigation;
3. FESS is associated with minimal blood loss. Elevated blood loss has been associated with infection risk. In addition, clotted blood is a possible breeding ground for bacteria.

Furthermore, the authors of this study have not only analyzed the complication rates but also
innovated new techniques for complication management in FESS. For instance, the article titled “Incidence and management of dural tears in full‑endoscopic unilateral laminotomies for bilateral lumbar decompression” by Madeline E. Greil, Julia Bergquist, Osama N. Kashlan, Woo-Keun Kwon, Sharon Durfy and Christoph P. Hofstetter, explores FESS’s ability to effectively repair dural tears. Intraoperative dural tears, a commonly reported complication of spine surgery, can lead to cerebrospinal fluid leaks and subsequent infections. In open procedures, primary repair of incidental durotomies is frequently performed.

However, in FESS, given the small diameter of the working channel and single portal, primary repair can be challenging without converting to an open procedure. In this article, an innovative method for bimanual intraoperative endoscopic dural repair is described, and its efficacy in repairing dural lacerations in interlaminar LE-ULBD cases is demonstrated.

Overall, FESS marks a paradigm shift in the field of spinal surgery. With its advanced visualization and fully specialized instrumentation, FESS not only offers a lower complication rate compared to traditional procedures but also demonstrates significant advantages in terms of lowe infection rates and the effective repair of dural tears. These two publications underscore the immense potential of FESS in improving patient safety and surgical outcomes, aligning with the broader healthcare goal of minimizing the burden of post-operative complications.