3D Exoscopic Surgery (3Des) for Transoral Oropharyngectomy

Abstract

Over the past three decades, the incidence of oropharyngeal squamous cell carcinoma has increased, primarily related to the spread of human papillomavirus. Treatment has always been preferentially unimodal (surgery or radiotherapy) for early stage disease and multimodal (surgery with adjuvant therapy or concomitant chemoradiotherapy) for advanced stages. Recently, the surgical approach has gained renewed interest due to the morbidity of non-surgical treatments and also to technical innovations. We have coined the term 3Des (3D exoscope surgery) to describe the use of the 3D Vitom Exoscope System for transoral surgery of oropharyngeal cancers. During the period from June 2017 to May 2018, 10 patients with oropharyngeal cancer were treated by oropharyngeal surgery with the 3Des approach at FPO IRCCS Institute of Candiolo. The aim of the present prospective study was to evaluate the utility of 3Des for the treatment of early-stage oropharyngeal cancer. 3Des could represent a viable alternative to the operating microscope and robotic surgery thanks to its excellent ability to provide 3D visual information, depth of field, magnification, image contrast, color imaging, and low running costs. It promises great utility in the learning process, with the possibility of recording in high definition.

VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

“…Both images and video sequences can be stored in high definition, enabling surgeons to share videos in didactic sessions, meetings and surgical technique courses. This utility applies not only to neck dissection, but also to the treatment of primary tumours 8 . At present, in a health policy aimed at reducing costs, it is difficult to procure up-to-date technologies.…”

“…Of these, the main the duration of surgery, longer than the standard approach, the need for surgeons to develop skills in endoscopic and robotic techniques and the overall higher costs of the procedures (about six times higher in the Korean experience using robotic neck dissection) [3][4][5][6][7] . The recent introduction of 3D exoscopic surgery has allowed interesting technical improvements in head and neck surgery resulting in technical solutions that are also applicable to neck dissection, with the aim of replacing robotic surgery but minimising the costs of the procedure 8 . Specifically, exoscopic surgery is based on the use of a sterile 3D optical device, called an exoscope, placed in the surgical field and oriented with different inclinations but technically about 40 cm distant from it.…”

“…The recent introduction of 3D exoscopic surgery has allowed interesting technical improvements in head and neck surgery resulting in technical solutions that are also applicable to neck dissection, with the aim of replacing robotic surgery but minimising the costs of the procedure 8 .…”

Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic

“…In line with other surgeons who have previously trialled the video-assisted telescope operating monitor, our surgeon found setting up easy and intuitive. 6 …”

Microsurgical procedures during COVID-19 pandemic: the VITOM® 3D-HD exoscopic system as alternative to the operating microscope to properly use personal protective equipment (PPE)

“…When the 3D-HD system of vision is employed in particular settings, as for oral cavity or oropharyngeal lesions [ 9 ], or reconstructive surgery [ 10 ], or otoneurosurgery [ 11 ], where micromanipulator for the CO 2 laser is not needed, traditional cold instruments, monopolar scalpels, or fiber lasers can be employed as cutting devices. The disposition of the nurse’s master table and secondary table, as well as the anesthesia device or other surgical devices in the operatory room, is not further influenced by the application of this setting and is totally similar to a traditional procedure.…”