TESSYS® - Transforaminal Endoscopic Surgical System

This informative animation shows you the TESSYS Surgical Process in action.

[ Click here to view the TESSYS Surgical Animation.]

Surgical Indications

The surgical indications for a TESSYS™ operating technique are similar to traditional microdiscectomy. Patients with radicular symptoms caused by a herniated intervertebral disc or protrusion who have failed non-operative management with physical therapy, traction, non-steroidal medication, and watchful waiting, are candidates for endoscopic transforaminal removal of the offending disc fragment. Preoperative work should include magnetic resonance imaging (MRI) and/or computer tomography (CT) and lumbar X-rays including anterior-posterior, lateral and

The triangular working zone according to Parviz Kambin and the target area of the THESSYS™ approach.

flexion-extension views. The presence of a cauda equina syndrome represents an indication for immediate surgical intervention. In addition, a sequestered herniated lumbar disc posterior to the dural sack is a contraindication as it is impossible to reach with the TESSYS™ procedure.

The TESSYS™ method uses the lateral endoscopic access via the foramen for removal of the herniated disc. The incision for transforaminal endoscopic surgery (TES) is extremely small, and the surgery can be performed under local anesthesia with sedation in the outpatient setting. The multiple advantages of transforaminal endoscopic surgery are; local versus general anesthetic, reduced risk of infection and instability, fewer subsequent scars, keyhole surgery and a quicker recovery time. Most patients can get up after a few hours and leave the hospital the same day.

With the use of special endoscopic instruments through small incisions, the surgeon can remove and cut off tissue directly and under constant camera control.  The patients are given local and IV sedation/pain medication and remain awake and responsive during the entire surgery which allows the surgeon to appreciate possible pain reactions more effectively. In the lateral position with flexed hips, lordosis is decreased enabling easier access.

TESSYS™ Surgical Technique

Proper patient positioning and thorough preoperative planning of the approach to the herniated intervertebral disc are essential when working with the TESSYS™ method. Confirmation of the position of the annular tear, protrusion and/or sequestrated disc material can be obtained by intra-operative discography.  A TESSSYS™ procedure can be performed either in the prone or in the lateral position.

Lateral Position: The patient is placed on the operating table in the lateral position with the side of the herniation facing up. The patient can be positioned with a bean bag or a pillow roll under the waist. The patient’s legs are gently bent at the hips and knees.
 Stable lateral position

Prone Position: Alternatively, the patient can be placed in the prone position on a Wilson frame. Biplanar fluoroscopy is used in either position to determine the operative level. Attention should be paid to obtain true posterior-anterior and lateral views for reliable targeting.

Under constant fluoroscopic control, the surgeon inserts a set of guiding rods, guiding- and working tubes, and reamers from the TESSYS™ instrument tray. In doing so the foramen is slowly and progressively dilated. Via this safe access to the spinal canal, the surgeon can then remove the herniated disc under full endoscopic image control using specially developed foraminoscopes and forceps.

Contact joimax USA, inc. to request information about the TESSYS™surgical method and products.