Objective: We present a prospective, non-comparative case series study of 126 consecutive diode laser-assisted transcanalicular dacryocystorhinostomy (TCL-DCR) procedures on 122 patients. We analyzed success rate, procedure time and amount of laser energy needed for a 5 mm osteotomy.
Materials and Methods: One hundred and twenty-two patients with nasolacrimal duct obstruction were included in the study. The procedure was performed under general anesthesia, and the nasal mucosa was anesthetized. An endoscope was used for examination of the lacrimal pathways. The site of osteotomy was determined with transillumination of the lateral nasal wall. We achieved osteotomy by applying laser energy via an optic fiber. We used a 980 nm diode laser with power of 10 Watts. We inserted a bicanalicular silicone stent as the last step. Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective).
Results: We performed 126 successive endoscopic laser (EL-DCR) with bicanalicular intubation in 122 patients. The average procedure time was 12 min, and on average 245 Joules of laser energy was needed. The silicone stents were removed three to eight months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 105 out of 126 treated eyes. Eighteen patients had epiphora despite a patent nasolacrimal duct on irrigation. This yields a success rate of 83.3%, with an average follow-up period of 12 months.
Conclusions: The 980 nm EL-DCR with bicanalicular intubation is a new contribution to the field of lacrimal surgery. It is a minimally invasive quick procedure yielding a high success rate.
Keywords: Dacryocystorhinostomy, lacrimal surgery, minimal invasive surgery, silicone stent intubation, transnasal approach, 980 nm diode laser

The first intranasal approach was described in 1889 by Killian, and endoscopic dacryocystorhinostomy (DCR) was first performed by Caldwell in 1893, but was soon abandoned due to difficult visualization and numerous complications.  However, with the advent of new technology used in endoscopic sinus surgery, permitting better visualization, the endoscopic approach has been revived. This approach permits direct visualization of the lateral nasal wall in the middle nasal meatus, where the osteotomy is performed. The advantages of transnasal endoscopic DCR (TNE-DCR) over external DCR are:  No outer skin incision with resulting scar, shorter procedure time, and shorter patient recovery time.