TESSYS® – Transforaminal Endoscopic Surgical System
Slipped discs are considered a widespread condition. Men are affected twice as often as women. Minimally invasive spinal surgery has developed into an alternative and reliable treatment method for a variety of spinal complaints. The TESSYS® method uses the lateral transforaminal endoscopic approach, which can generally be classified as an extremely patient-friendly surgical approach.
The TESSYS® Family
In order to cover the full range of indications, applications and patients, we offer TESSYS® in different variants.
![TESSYS THX](https://www.joimax.com/wp-content/uploads/2024/02/TESSYS-THX-e1708005608720.jpg)
![TESSYS_Thx](https://www.joimax.com/wp-content/uploads/2023/07/TESSYS_Thx-300x53.png)
According to the Wooridul Group
The differently shaped vertebrae and the spatial restrictions imposed by the ribs and the pleura present the surgeon with particular challenges when treating thoracic stenoses and herniated discs.
The TESSYS® Thx instrument set is suitable for these challenges, especially for central and paramedian stenoses and herniated discs.
The narrower endoscope shaft enables use in confined spaces and the larger optical angle offers an excellent view of all structures in the surgical field.
![TESSYS XT](https://www.joimax.com/wp-content/uploads/2024/02/TESSYS-XT.jpg)
![TESSYS_XT](https://www.joimax.com/wp-content/uploads/2023/07/TESSYS_XT-300x53.png)
The main difference between the XT version and the standard set is the longer working length of the XT version’s endoscope and working tubes. Due to the longer reach, it is also possible to treat very adipose patients.
The TESSYS® Surgery
The TESSYS® surgical method is used both in hospitals and outpatient surgery centers. With this method, the surgeon resects the herniated disc via the lateral access route through the intervertebral foramen. He therefore uses the natural route in-between the superior articular processes, the endplate of the lower vertebra and the nerve roots (Kambin triangle). Using special instruments, the surgeon gradually and gently enlarges the transforaminal approach step by step. Under endoscopic view sequestered disc material is removed completely and directly through the foramen.
![Layout 1 Layout 1](https://www.joimax.com/wp-content/uploads/2023/06/Kambin-Dreieck-650x400.jpg)
The TESSYS® Surgery
The TESSYS® surgical method is used both in hospitals and outpatient surgery centers. With this method, the surgeon resects the herniated disc via the lateral access route through the intervertebral foramen. He therefore uses the natural route in-between the superior articular processes, the endplate of the lower vertebra and the nerve roots (Kambin triangle). Using special instruments, the surgeon gradually and gently enlarges the transforaminal approach step by step. Under endoscopic view sequestered disc material is removed completely and directly through the foramen.
![Layout 1 Layout 1](https://www.joimax.com/wp-content/uploads/2023/06/Kambin-Dreieck-650x400.jpg)
To avoid irritation of the nerves in the foramen, the caudal part of the intervertebral foramen is widened step by step using special reamers. This is particularly important if the foramen is narrow due to the location of the disease or the age of the patient. In this case, bone material must be removed.
A TESSYS® operation can be performed in prone or lateral position. Patients can receive either general anesthesia or MAC. If the surgery is performed under MAC, patients are able to react immediately upon possible contact with neural elements. Many patients get up just a few hours after the surgery.
To avoid irritation of the nerves in the foramen, the caudal part of the intervertebral foramen is widened step by step using special reamers. This is particularly important if the foramen is narrow due to the location of the disease or the age of the patient. In this case, bone material must be removed.
A TESSYS® operation can be performed in prone or lateral position. Patients can receive either general anesthesia or MAC. If the surgery is performed under MAC, patients are able to react immediately upon possible contact with neural elements. Many patients get up just a few hours after the surgery.
Selected Indications
- Herniated discs
- Spinal stenosis
- Degenerative disease of ligamentum flavum
- Cauda equina syndrome
- Dorsal facet joint cysts
![joimax_TESSYS TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3 joimax_TESSYS TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3](https://www.joimax.com/wp-content/uploads/2023/06/joimax_TESSYS-TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3-650x400.png)
Selected Indications
- Herniated discs
- Spinal stenosis
- Degenerative disease of ligamentum flavum
- Cauda equina syndrome
- Dorsal facet joint cysts
![joimax_TESSYS TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3 joimax_TESSYS TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3](https://www.joimax.com/wp-content/uploads/2023/06/joimax_TESSYS-TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3-650x400.png)
Selected Indications
- Herniated discs
- Spinal stenosis
- Degenerative disease of ligamentum flavum
- Cauda equina syndrome
- Dorsal facet joint cysts
![joimax_TESSYS TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3 joimax_TESSYS TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3](https://www.joimax.com/wp-content/uploads/2023/06/joimax_TESSYS-TransSAP_OP_Beschreibung_EN_TD_TEIS_13_GA_008_Rev001_2022-9_Final3-650x400.png)
Innovative Solutions – Unique Benefits
- Smaller incision
- Less trauma/less scarring/better cosmesis
- Reduced blood loss
- Less pain
- Improvement of pain and mobility, improved quality of life
- Faster recovery time
![DSC_0170](https://www.joimax.com/wp-content/uploads/2023/08/DSC_0170-scaled-e1708006879965-1024x855.jpg)
Innovative Solutions – Unique Benefits
- Smaller incision
- Less trauma/less scarring/better cosmesis
- Reduced blood loss
- Less pain
- Improvement of pain and mobility, improved quality of life
- Faster recovery time
![DSC_0170](https://www.joimax.com/wp-content/uploads/2023/08/DSC_0170-scaled-e1708006879965-1024x855.jpg)
The TESSYS® Gallery
Disclaimers
Certain products may not be approved for sale in all countries.
Scientific Literature for TESSYS®
[1] Initial learning curve after switching to uniportal endoscopic discectomy for lumbar disc herniations
Olinger C, Coffman A, Campion C, Thompson K, Gardocki R; Eur Spine J 2023
[2] A comparative study of percutaneous endoscopic interlaminar discectomy and transforaminal discectomy for L5-S1 calcified lumbar disc herniation
Cheng Y-P, Cheng X-K, Wu H; BMC Musculoskeletal Disorders (2022) 23: 244
[3] Clinical efficacy of transforaminal endoscopic lumbar discectomy for lumbar degenerative diseases: A minimum 6-year follow-up
Tang J, Li Y, Wu C, Xie W, Li X, Gan X, Lu Q; Front Surg (2022) 9: 1004709
[4] Comparison of Interlaminar and Transforaminal Approaches for Treatment of L5/S1 Disc Herniation by Percutaneous Endoscopic Discectomy
Gao A, Yang H, Zhu L, Hu Z, Lu B, Jin Q, Wang Y, Gu X; Orthop Surg (2021) 13: 63–70
[5] Comparative Analysis of Transforaminal Endoscopic Thoracic Discectomy and Microscopic Discectomy for Symptomatic Thoracic Disc Herniation
Bae J, Kim J, Lee S-H, Kim J-S; Neurospine (2022) 19: 555–562
[6] Treatment of Refractory Multilevel Thoracic Spondylodiscitis Using Ultra-Minimally Invasive Endoscopic Approach for Debridement and Drainage: A Technical Note, Intraoperative Video and Literature Review
Barber SM, Sofoluke N, Reardon T, Telfeian A, Konakondla S; World Neurosurgery (2022)
[7] Full Endoscopic Surgery for Thoracic Pathology: Next Step after Mastering Lumbar and Cervical Endoscopic Spine Surgery?
Bae J, Lee S-H, Wagner R, Shen J, Telfeian AE; BioMed Research International (2022): e8345736
[8] Endoscopic Spine Surgery of the Cervicothoracic Spine: A Review of Current Applications
Shen J, Shaaya E, Bae J, Telfeian AE; Int J Spine Surg (2021) 15: S93–S103
[9] Full endoscopic surgery for thoracic pathology: an assessment of supportive evidence
Gibson R, Wagner R, Gibson A; EOR, volume 6, January 2021
[10] Fully Endoscopic 360° Decompression Surgery for Thoracic Spinal Stenosis: Technical Note and Report of 8 Cases
Shen J, Telfeian AE; Pain Physician (2020) 23: E659–E663
[11] Percutaneous Endoscopic Thoracic Decompression for Thoracic Spinal Stenosis Under Local Anesthesia
Cheng X-K, Chen B; World Neurosurgery (2020) 139: 488–494
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- Tang J, Li Y, Wu C, Xie W, Li X, Gan X et al. Clinical efficacy of transforaminal endoscopic lumbar discectomy for lumbar degenerative diseases: A minimum 6-year follow-up. Front Surg 2022; 9: 1004709.
- Lee J-K, Chung S-W, Lee S-H, Shin Y-H, Park C-H. Comparative Study of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Treating Cauda Equina Syndrome. J Minim Invasive Spine Surg Tech 2022. doi:10.21182/jmisst.2022.00542.
- Hagan MJ, Remacle T, Leary OP, Feler J, Shaaya E, Ali R et al. Navigation Techniques in Endoscopic Spine Surgery. BioMed Research International; : 12.
- Krzok G. Transpedicular Endoscopic Surgery for Highly Downmigrated L5-S1 Disc Herniation. Case Rep Med 2019; 2019: 5724342.
- Bing N, Tao D, Wei S, Guang L, Hongwei Z. Percutaneous Endoscopic C2-C3 Medial Branches Neurotomy for Cervicogenic Headache. World Neurosurgery 2019; 126: 498–501.
- Wu B, Xiong C, Huang B, Zhao D, Yao Z, Yao Y et al. Clinical Outcomes of TESSYS and TESSYS-ISEE Approach on Treatment of Lateral Recess Stenosis: A Comparison Study. In Review, 2020 doi:10.21203/rs.3.rs-44921/v1.
- Telfeian AE, Oyelese A, Fridley J, Ali R, Cielo D, Gokaslan ZL. A Transforaminal Endoscopic Surgical Technique for Treating Lumbar Disc Herniation in the Setting of Spina Bifida. Case Reports in Neurological Medicine 2020; 2020: 1–6.
- Liu X, Peng Y, Pei L, Zhu Y. Sufficient Lumbar Lateral Recess Decompression Acquired by Undercutting “Superior Articular Process Neck” Plus Intervertebral Disk Annuloplasty in Percutaneous Transforaminal Endoscopic Surgery. Med Sci Monit 2020; 26. doi:10.12659/MSM.921119.
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- Telfeian AE, Doberstein C, Oyelese AA, Fridley J, Donahue JE, Gokaslan Z. A Transforaminal Endoscopic Approach for Treatment of a Lumbar Perineural Cyst: Technical Note. World Neurosurgery 2019; 127: 85–91.
- Shu W, Zhu H, Liu R, Li Y, Du T, Ni B et al. Posterior percutaneous endoscopic cervical foraminotomy and discectomy for degenerative cervical radiculopathy using intraoperative O-arm imaging. wiitm 2019; 14: 551–559.
- Hagan MJ, Telfeian AE, Sastry R, Ali R, Lewandrowski K-U, Konakondla S et al. Awake transforaminal endoscopic lumbar facet cyst resection: technical note and case series. J Neurosurg Spine 2022; : 1–8.
- Barber SM, Sofoluke N, Reardon T, Telfeian A, Konakondla S. Treatment of refractory multilevel thoracic spondylodiscitis using ultra-minimally invasive endoscopic approach for debridement and drainage: a technical note, intraoperative video and literature review. World Neurosurgery 2022. doi:10.1016/j.wneu.2022.08.034.
- Bajaj A, Telfeian AE. Pediatric Applications of Endoscopic Spine Surgery. Interdisciplinary Neurosurgery 2022; : 101642.
- Krzok G, Telfeian AE, Wagner R, Iprenburg M. Transpedicular endoscopic surgery for lumbar spinal synovial cyst-report of two cases. J Spine Surg 2016; 2: 310–313.
- Kim J, Lee DC, Kim TH, Park CK. Full Endoscopic Interlaminar Contralateral Lumbar Foraminotomy for Recurrent L5-S1 Foraminal-extraforaminal Stenosis: A Case Report with a Technical Note. J Minim Invasive Spine Surg Tech 2022. doi:10.21182/jmisst.2022.00528.
- Percutaneous full-endoscopic C2 ganglionectomy for the treatment of intractable occipital neuralgia: technical feasibility and preliminary results. 2022. doi:10.21203/rs.3.rs-1755585/v1.
- Telfeian AE, Bajaj A, Sastry R, Ali R, Oyelese A, Fridley J et al. Foraminal Access Strategies in Patients with Lumbar Posterolateral Fusions in Transforaminal Endoscopic Spine Surgery: Case Series and Technical Note. Pain Physician 2022; : 8.
- Bae J, Lee S-H, Wagner R, Shen J, Telfeian AE. Full Endoscopic Surgery for Thoracic Pathology: Next Step after Mastering Lumbar and Cervical Endoscopic Spine Surgery? BioMed Research International 2022; 2022: e8345736.
- Kravtsov MN, Manukovsky VA, Mirzametov SD, Malysheva OV, Averyanov DA, Svistov DV. Percutaneous Transforaminal Full-Endoscopic Removal of Neurinoma of the Fifth Lumbar Nerve Root With Intraoperative Neuromonitoring: A Case Report. Front Surg 2022; 9: 877974.
- Moraes Amato MC, Aprile BC, Esteves LA, Carneiro VM, Oliveira RS de. Full Endoscopic Thoracic Discectomy: Is the Interlaminar Approach an Alternative to the Transforaminal Approach? A Technical Note. Int J Spine Surg 2022; 16: 309–317.
- Xiao C, Yin W, Zhao K, Luo J, Huang W, Liu W. Early Clinical Efficacy of Endo-TLIF in the Treatment of Lumbar Disc Herniation. Z Orthop Unfall 2022. doi:10.1055/a-1795-4038.
- Telfeian AE, Sastry R, Oyelese A, Fridley J, Camara-Quintana JQ, Niu T et al. Awake, Transforaminal Endoscopic Lumbar Spine Surgery in Octogenarians: Case Series. Pain Physician 2022; 25: E255–E262.
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- Wagner R, Telfeian AE, Iprenburg M, Krzok G, Gokaslan Z, Choi DB et al. Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation. World Neurosurg 2016; 90: 194–198.
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- Kosztowski TA, Choi D, Fridley J, Galgano M, Gokaslan Z, Oyelese A et al. Lumbar disc reherniation after transforaminal lumbar endoscopic discectomy. Ann Transl Med 2018; 6: 106.
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- Telfeian AE, Oyelese A, Fridley J, Doberstein C, Gokaslan ZL. Prognosis for recovery of foot drop after transforaminal endoscopic decompression of far lateral lumbar 5-sacral 1 herniated disc: Case series. Pain Phys 2019; 22: E97–E103.
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- Shen J, Shaaya E, Bae J, Telfeian AE. Endoscopic Spine Surgery of the Cervicothoracic Spine: A Review of Current Applications. Int J Spine Surg 2021; 15: S93–S103.
- Gao A, Yang H, Zhu L, Hu Z, Lu B, Jin Q et al. Comparison of Interlaminar and Transforaminal Approaches for Treatment of L 5 /S 1 Disc Herniation by Percutaneous Endoscopic Discectomy. Orthop Surg 2021; 13: 63–70.
- Telfeian AE. Endoscopic foraminotomy for recurrent lumbar radiculopathy after TLIF: Technical report. Surg Neurol Int 2015; 6: 62.
- Telfeian AE, Moldovan K, Shaaya E, Syed S, Oyelese A, Fridley J et al. Awake, Endoscopic Revision Surgery for Lumbar Pseudarthrosis After Transforaminal Lumbar Interbody Fusion: Technical Notes. World Neurosurgery 2020; 136: 117–121.
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- Zhou Z, Ni H-J, Hu S, Fan Y-S, Wang C-F, Chen X et al. Original Designed Uniportal-Bichannel Spinal Endoscopic System (UBiSES) for Foraminoplasty in Percutaneous Endoscopic Transforaminal Discectomy. Orthop Surg 2021. doi:10.1111/os.13050.
- Telfeian AE, Veeramani A, Zhang AS, Quinn MS, Daniels AH. Transforaminal 360° lumbar endoscopic foraminotomy in postfusion patients: technical note and case series. J Neurosurg Spine 2021; : 1–7.
- Telfeian AE, Oyelese A, Fridley J, Gokaslan ZL. Transforaminal Endoscopic Surgical Treatment for Posterior Migration of Polyetheretherketone Transforaminal Lumbar Interbody Fusion Cage: Case Series. World Neurosurg 2021; 147: e437–e443.
- Telfeian AE, Oyelese A, Fridley J, Camara-Quintana JQ, Niu T, Gokaslan ZL. Transforaminal Endoscopic Surgical Treatment for Postlaminectomy Lumbar Radiculopathy: Case Series. World Neurosurg 2021; 150: e577–e584.
- Yu Y, Jiang Y, Xu F, Mao Y, Yuan L, Li C. A novel vertebral trench technique (VTT) involving transforaminal endoscopic lumbar foraminotomy (TELF) for very highly up-migrated lumbar disc herniation above L5. BMC Musculoskeletal Disorders 2021; 22: 693.
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- Tacconi L, Spinelli R, Serra G, Signorelli F, Giordan E. Full-Endoscopic Removal of Lumbar Juxtafacet Cysts: A Prospective Multicentric Study. World Neurosurgery 2020; 141: e414–e422.
- Porto GBF, Cisewski SE, Wolgamott L, Frankel BM. Clinical outcomes for patients with lateral lumbar radiculopathy treated by percutaneous endoscopic transforaminal discectomy versus tubular microdiscectomy: A retrospective review. Clinical Neurology and Neurosurgery 2021; 208: 106848.
- Krzok G, Telfeian AE, Wagner R, Hofstetter CP, Iprenburg M. Contralateral facet-sparing sublaminar endoscopic foraminotomy for the treatment of lumbar lateral recess stenosis: technical note. J Spine Surg 2017; 3: 260–266.
- Hussain I, Rapoport BI, Krause K, Kinney G, Hofstetter CP, Elowitz E. Transforaminal Endoscopic Lumbar Discectomy and Foraminotomy with Modified Radiofrequency Nerve Stimulator and Continuous Electromyography Under General Anesthesia. World Neurosurg 2020; 137: 102–110.
- Konakondla S, Sofoluke N, Xia J, Grant R, Telfeian AE, Hofstetter CP et al. Transforaminal Endoscopic Approach for Large-Sample Tumor Biopsy using Beveled Working Channel for Core Technique: A Technical Note. World Neurosurg 2020; 141: 346–351.
- Jasper GP, Francisco GM, Telfeian AE. Endoscopic transforaminal discectomy for an extruded lumbar disc herniation. Pain Physician 2013; 16: E31-35.
- Lin Y-P, Wang S-L, Hu W-X, Chen B-L, Du Y-X, Zhao S et al. Percutaneous Full-Endoscopic Lumbar Foraminoplasty and Decompression by Using a Visualization Reamer for Lumbar Lateral Recess and Foraminal Stenosis in Elderly Patients. World Neurosurg 2020; 136: e83–e89.
- Chen C, Ma X, Zhao D, Yang H, Xu B, Wang Z et al. Full Endoscopic Lumbar Foraminoplasty with Periendoscopic Visualized Trephine Technique for Lumbar Disc Herniation with Migration and/or Foraminal or Lateral Recess Stenosis. World Neurosurg 2021; 148: e658–e666.
- Xiong C, Li T, Kang H, Hu H, Han J, Xu F. Early outcomes of 270-degree spinal canal decompression by using TESSYS-ISEE technique in patients with lumbar spinal stenosis combined with disk herniation. Eur Spine J 2019; 28: 78–86.
- Li J, Xu C, Zhang X, Xi Z, Liu M, Fang Z et al. TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study. BMC Musculoskeletal Disorders 2021; 22: 616.
- Kim HS, Wu PH, Jang I-T. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci 2020; 21: E1483.
- Telfeian AE. An awake, minimally-invasive, fully-endoscopic surgical technique for treating lumbar radiculopathy secondary to heterotopic foraminal bone formation after a minimally invasive transforaminal lumbar interbody fusion with BMP: technical note. J Spine Surg 2018; 4: 162–166.
- Li X, Jin L, Lv Z, Su X, Wang K, Shen H et al. Efficacy of percutaneous transforaminal endoscopic decompression treatment for degenerative lumbar spondylolisthesis with spinal stenosis in elderly patients. Exp Ther Med 2019. doi:10.3892/etm.2019.8337.
- Jing Z, Li L, Song J. Delayed neurological deficits caused by cement extravasation following vertebroplasty: a case report. J Int Med Res 2021; 49: 03000605211019664.
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