title: Transseptal access with crossing multiple incisions for improved pedicle control and septum preservation: "How I do it".
abstract: BACKGROUND
  Recently, the surgical management of nasal tumors has been greatly influenced by advanced endoscopic techniques. To achieve complete endoscopic resection of large obstructing nasal tumors, a sufficient corridor for adequate exposure is also required. In the Japanese language, TACMI means "master expert," and herein we describe an endoscopic technique with novel elements that we term transseptal access with crossing multiple incisions (TACMI). This approach enables a direct transseptal approach to the pedicle through tumor transposition while allowing complete septal reconstruction and stability.
  
  
  METHODS
  We prospectively collected data from eight patients who underwent the TACMI approach for sinonasal tumors.
  
  
  RESULTS
  When using TACMI, complete en bloc neoplasm resection was achieved in all but one patient, who underwent piecemeal tumor removal. The follow-up duration ranged from 10 to 28 months (mean, 19 months). None of the patients experienced septal perforation, nasal valve incompetence, or tumor recurrence.
  
  
  CONCLUSIONS
  We presented evidence that TACMI was a simple, efficient, and effective technique for tumor transposition, and for pedicle visualization and access of challenging unilateral sinonasal lesions. These advantages contributed to limited blood loss, improved pedicle control, and complete nasal valve and septum preservation without functional deficits.
authors.affiliation: Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Omura
authors.forename: Daiya
authors.initials: D
authors.lastname: Asaka
authors.forename: Jayakar V
authors.initials: JV
authors.lastname: Nayak
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery*; D018308:Papilloma, Inverted / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D000072836:Surgical Wound