High Definition Three-Dimensional Exoscope (VITOM 3D) in E.N.T. Surgery: A Systematic Review of Current Experience

Abstract

Over the last decade, technological growth has developed new devices for more precise surgery based on improved maneuverability, minimally invasive approaches, and magnification of the operating field. In this context, the exoscope has opened a new phase for more accurate and safer microsurgery, improving the perception of the volume of objects and the depth of structures for planning, targeting, and controlling fine movements. The exoscope could be used for middle ear, transcanal, transmastoid, and craniotomy procedures that require two-handed dissection, both to perform both totally VITOM-based techniques and coupled to traditional procedures with an operating microscope or endoscope. In addition, the VITOM 3D system allows the surgeon to work with high-definition images, which is essential in facial nerve surgery or submandibular salivary stone or tear surgery approaches, where magnification plays a fundamental role in surgical success and in reducing operating times. The 3D exoscope approach could also be included in traditional transoral procedures for oropharyngeal carcinoma. The exoscope may provide a relevant approach in teaching surgeons and nurses, allowing adequate training in non-oncological surgical procedures such as a tonsillectomy or lateral pharyngoplasty.

3D‐4K Exoscope‐Assisted CO2 Laser Supraglottoplasty for Severe Laryngomalacia in a Pediatric Patient

“…3D-4K exoscopic surgery is currently spreading in many head and neck surgical fields, 2,3 especially in laryngeal surgery. 2 Supraglottoplasty, a procedure used to treat laryngomalacia, can be performed in various ways, most of which are less expensive than the 3D-4K exoscope-assisted method. These alternative approaches also consider the additional costs associated with instruments and personnel training.…”

“…3 The main advantages of 3D-exoscopy over microscopy and conventional endoscopy, are: depth of the surgical field, the 3D visualization of anatomical structures, a longer focal length creating a wider working space, improved camera handling thanks to the combined use of a mechanical arm, the ARTip CruiseTM (Karl Storz, Tuttlingen, Germany), allowing the surgeon to explore the surgical field without the anatomical limitations of microscopy. 2,3 Moreover, surgery can be performed in a more ergonomic position thanks to the transmission of the images on a 4K 3D screen, placed at the eye level of the main surgeon, reducing the physical and mental demand and frustration for the surgeon; this setting facilitates the transmission of knowledge to students, and can be used for training, thanks also to the possibility of creating videos for the surgical training. 3 To the best of our knowledge, the use of a 3D-4K exoscope for laryngeal surgery on pediatric patients has not been previously reported in the literature.…”

“…Traditionally, surgery is performed using a microscope and cold knife, carbon dioxide (CO 2 ) laser, microdebrider or coblation 1 2 ; however, only a few pediatric series have been published so far, focusing primarily on ear surgery 3 . The main advantages of 3D‐exoscopy over microscopy and conventional endoscopy, are: depth of the surgical field, the 3D visualization of anatomical structures, a longer focal length creating a wider working space, improved camera handling thanks to the combined use of a mechanical arm, the ARTip CruiseTM (Karl Storz, Tuttlingen, Germany), allowing the surgeon to explore the surgical field without the anatomical limitations of microscopy 2,3 .…”

An Early Report of Exoscope-assisted Otologic Surgery

“…7 Nevertheless, there is still room for improvement in its popularization and application. 8 Advantages of exoscope, as stated in previous studies, include superior ergonomics, compact size, teaching potential, and a better tent drape to prevent virus transmission by aerosols during the COVID pandemic. 9 But the experience of exoscope utilization in Asian countries is lacking, and there is a paucity of subjective questionnaires among different attendants in the operation room.…”

Improvement of Surgical View and Working Space at the Lower Pole by Three-Dimensional Exoscope-Assisted Coblation Tonsillectomy: A Case Series

“…The utility of surgical microscopes and endoscopes for precisely identifying anatomy in hot technique tonsillectomy has been reported [ 3 , 6 , 7 , 8 , 9 ]. The three-dimensional (3D) surgical exoscope has, for example, been applied in the field of otorhinolaryngology head and neck surgery [ 10 , 11 , 12 ]. Notably, in transoral pharyngolaryngeal surgery, use of the surgical exoscope has advantages compared with conventional microscopic or endoscopic surgery, including high definition and high magnification 3D images, flexibility of camera position and angle, and wide working space [ 11 ].…”