Introducing the High-definition 3D exoscope in ear surgery: preliminary analysis of advantages and limits compared with operative microscope

Colombo, Giovanni; Ferreli, Fabio; Bari, Matteo Di; Cugini, Giovanni; Miceli, Stefano; Spriano, Giuseppe; Poletti, Alessandro

doi:10.1007/s00405-020-06510-w

Cited by 27 publications

(39 citation statements)

References 13 publications

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“…Only six cases have been described in the literature regarding the application of the 3D imaging system in cochlear implant surgery and not all used the exoscope exlcusively. [1][2][3][4] In our case, both leftand right-side cochlear implant procedures were performed entirely with the 3D exoscope system.…”

Section: Discussionmentioning

confidence: 99%

A three-dimensional exoscope system for bilateral simultaneous cochlear implant surgery: how I do it

2022

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Background This paper reports the first case of simultaneous bilateral cochlear implant surgery performed exclusively with a three-dimensional exoscope. It also discusses the optimum operative set-up and the feasibility of three-dimensional exoscopic ear surgery as an alternative to the microscope. Method The Vitom three-dimensional exoscope system (Karl Storz) was used. Results The surgery was successfully completed, with no peri-operative complications. Both the operation time and the surgical outcome for the patient were comparable with the previous cochlear implant surgical procedures performed in our centre using the conventional operating microscope. Conclusion This paper demonstrates that exclusive use of the three-dimensional exoscope is a viable alternative to the operating microscope for selected otological cases. It is clear that the three-dimensional exoscopic technique is potentially very promising for future surgical procedures, provided that cases are selected carefully to prevent compromising exposure, efficiency or patient safety.

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Section: Discussionmentioning

confidence: 99%

A three-dimensional exoscope system for bilateral simultaneous cochlear implant surgery: how I do it

2022

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“…For RobOtol®, as the routine surgical workflow was barely disturbed, the additional surgical time required could be explained by the following three points. First, RobOtol® changes the regular surgical layout, as the lateral or front side of the surgeon is completely occupied, leading to interference with the microscope and nurse, and requiring repositioning, so that introducing an exoscope could solve part of the problem ( 34 ). Second, the high precision of the robotic arm limits its operating space to a 20 cm range thus the comfortable positioning of the robotic arm in the vicinity of the mastoidectomy is extended by ~3.5 min.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

Jia

Pan

et al. 2021

Front. Surg.

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Background: As an advanced surgical technique to reduce trauma to the inner ear, robot-assisted electrode array (EA) insertion has been applied in adult cochlear implantation (CI) and was approved as a safe surgical procedure that could result in better outcomes. As the mastoid and temporal bones are generally smaller in children, which would increase the difficulty for robot-assisted manipulation, the clinical application of these systems for CI in children has not been reported. Given that the pediatric candidate is the main population, we aim to investigate the safety and reliability of robot-assisted techniques in pediatric cochlear implantation.Methods: Retrospective cohort study at a referral center in Shanghai including all patients of simultaneous bilateral CI with robotic assistance on one side (RobOtol® system, Collin ORL, Bagneux, France), and manual insertion on the other (same brand of EA and CI in both side), from December 2019 to June 2020. The surgical outcomes, radiological measurements (EA positioning, EA insertion depth, mastoidectomy size), and audiological outcomes (Behavior pure-tone audiometry) were evaluated.Results: Five infants (17.8 ± 13.5 months, ranging from 10 to 42 months) and an adult (39 years old) were enrolled in this study. Both perimodiolar and lateral wall EAs were included. The robot-assisted EA insertion was successfully performed in all cases, although the surgical zone in infants was about half the size in adults, and no difference was observed in mastoidectomy size between robot-assisted and manual insertion sides (p = 0.219). The insertion depths of EA with two techniques were similar (P = 0.583). The robot-assisted technique showed no scalar deviation, but scalar deviation occurred for one manually inserted pre-curved EA (16%). Early auditory performance was similar to both techniques.Conclusion: Robot-assisted technique for EA insertion is approved to be used safely and reliably in children, which is possible and potential for better scalar positioning and might improve long-term auditory outcome. Standard mastoidectomy size was enough for robot-assisted technique. This first study marks the arrival of the era of robotic CI for all ages.

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“…The head-up surgery position frontal to the monitor is much more ergonomic and comfortable [ 14 ]. Furthermore, while both microscope and exoscope remain outside the surgical field, the latter grants 3D vision to the whole surgical team, immersing them in the operator’s perspective [ 6 , 8 – 11 ]. While surgical steps are the same for microscopy and exoscopy, without the need to reposition the articulated arm, the exoscope independent joystick can be controlled by the assistant for zoom, brightness, and image capture without intervention from the operator [ 8 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The 3D digital image system allows the surgeon, wearing special glasses, to perform the procedure using a magnified image of the field on a 4K 3D monitor with significant comfort also for assistants and nurses, who are also granted magnified 3D vision. Though other otological applications have been already studied in selected case series [ 11 ], no study preliminarily evaluated the role of exoscope-assisted surgery in otosclerosis. This study aims to investigate the advantages, ergonomics, didactic value of a 4K 3D exoscopic system in performing endaural laser-assisted stapedotomy in a prospective series of stapedotomy patients, compared with a control group of microscope-assisted stapedotomy patients.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional exoscope-assisted laser stapedotomy: a preliminary experience

Milanesi¹,

Pasquariello²,

Saibene

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known advantages in otological surgery. This study aims to evaluate exoscopes role in stapes surgery, both from a surgical perspective and on the educational profile. Methods Seven consecutive otosclerosis patients underwent single-sided endaural laser stapedotomy with a 4K 3-dimensional exoscope. The surgical setting allowed all operating room personnel 3-dimensional vision. Pre- and postoperative pure tone audiometry and air-bone gaps, and information on the postoperative course and complications were systematically collected. An informal ergonomic evaluation was carried out by the operating room personnel and an informal didactic evaluation was provided by the trainees. A comparable group of microscope-assisted stapedotomy patients undergoing the same procedures and evaluations was chosen as a control group. Results Outcomes were solid in all patients, median air-bone gap decreased from 26.5 to 10 dB at the 3-month evaluation (p = 0.01, Wilcoxon’s test). No vertigo, tinnitus, or facial palsy was reported. The median operating time was 40 min. The compact design and configuration of the exoscope allowed more practical management of the operating theater. All personnel had the chance for a better understanding of the procedure and trainees felt more confident when asked to identify surgical landmarks and procedure steps. Audiological outcomes, operative times, and complication rates were not different between study and control groups. Conclusion Though further validation and systematic comparison with microscope- and endoscope-assisted stapedotomy are required, the exoscope proved a safe, practical, and educational tool.

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Introducing the High-definition 3D exoscope in ear surgery: preliminary analysis of advantages and limits compared with operative microscope

Cited by 27 publications

References 13 publications

A three-dimensional exoscope system for bilateral simultaneous cochlear implant surgery: how I do it

A three-dimensional exoscope system for bilateral simultaneous cochlear implant surgery: how I do it

Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

Three-dimensional exoscope-assisted laser stapedotomy: a preliminary experience

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