Initial Experience with 3‐Dimensional Exoscope‐Assisted Transmastoid and Lateral Skull Base Surgery

Abstract

Extracorporeal video microscopes, or “exoscopes,” provide high-definition views of the operative field and are alternatives to the operating microscope or loupes for large-corridor surgical approaches. In this proof-of-concept study, we aim to determine the feasibility of 3-dimensional exoscopes as alternatives to operating microscopes in otology and neurotology, espeically in conjunction with endoscopes. Eleven consecutive cases were performed using 3-dimensional exoscopes in place of, or as adjuncts to, the operating microscope. The exoscope was the sole visualization tool in 7 cases, with 4 including the use of an endoscope or microscope. There were no perioperative complications. Potential subjective advantages include superior ergonomics, compact size, and an equal visual experience for surgeons and observers. Limitations include low lighting in small surgical corridors and pixilation at high magnification. Exoscopes are potentially viable alternatives to the microscope in otologic and neurotologic surgery.

Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

“…The 3D exoscope was used to complete the LTBR and STBR without the necessity to bring in the OM at any portion of the procedure with no intraoperative complications, including intraoperative CSF leaks or inadvertent neurovascular injury. Although it has been cited to be the best suited for wider operative fields and has limitations in providing low lighting in narrow operative corridors for use in lateral skull base surgery, 6,8 in our experience, the 3D exoscope has provided excellent visualization and lighting in all portions of the procedures allowing for careful and precise dissection. During LTBR, a mastoidectomy, an extended facial recess approach (posterior tympanotomy), and drilling of the epitympanic and hypotympanic space are completed with no difficulty and appropriate visualization of middle ear structures and identification of landmarks.…”

Exoscope and Personal Protective Equipment Use for Otologic Surgery in the Era of COVID‐19

“…The use of exoscopes has recently gained traction in otologic/neurotologic surgery. 7,8 In the current article, we describe our use of the exoscope as well as a novel draping method to safely perform a high-risk, aerosol-generating otologic procedure. For this work, we obtained exempt status from the NYU Langone Health Institutional Review Board.…”

High‐definition three‐dimensional exoscope for head and neck reconstruction: Prospective analysis of 27 consecutive patients

“…Finally, we should consider that the OE advantages are directly dependent on the specific surgical procedure performed. The widespread of the OE in otolaryngology is now associated to a variety of sub‐specialties such as laryngology, 5,17,18 neurotology, and skull base surgery, 2,19 other than head and neck reconstruction 8,10‐12,16 . Although some papers have been already published, the benefits of this technology have not been fully addressed and further data are required to improve this system in the near future.…”