Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

Abstract

Background High-definition, three-dimensional (3D) exoscopes are being used to perform a growing number of head and neck surgeries. However, the use of the 3D exoscope in parotid gland surgery has not been previously described. Our initial experience with the VITOM 3D exoscope in the surgical treatment of parotid gland tumors is detailed here. Methods We made a prospective study of patients with benign parotid gland tumors indicated for surgical resection. Between January and December 2018, patients were randomly assigned to undergo surgery assisted with the VITOM 3D system (n = 31) or an operating microscope (n = 40). Visualization quality (greater auricular nerve, digastric muscle, tragal pointer), operating time, conversion rates, and surgical outcomes were compared. Results A total of 71 patients underwent superficial (n = 18) or total parotidectomy (n = 53). No exoscope-related complications were observed. Five patients undergoing exoscope-guided deep lobe surgery required intraoperative conversion to a microscope. No differences were observed in the subjective quality of intraoperative visualization of key anatomical structures. However, a significantly higher percentage of patients in the exoscope group developed transient facial nerve paralysis (n = 9; 29% vs. n = 4, 10%). Conclusions These findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. However, the high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation.

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

“…The authors randomized 71 patients to traditional or VITOM-assisted surgery and analyzed outcomes such as visualization quality (major auricular nerve, digastric muscle, tragal pointer), operative time, conversion rates, and surgical outcomes. Although no significant differences were found between the two approaches regarding duration of surgery (97.9 ± 40.8 min vs. 92.1 ± 39.8; p = 0.551), superficial parotidectomy performed (n = 10; 33.3% vs. n = 8; 34.7% p = 0.938), or bleeding (n = 4; 10% vs. 4; 12.9%, p = 0.701), and no wound revision occurred in either group, a significantly higher rate of subjects in the exoscope group developed temporary facial nerve paralysis (n = 9; 29% vs. n = 4; 10%) [4]. Therefore, while these results on visualization for parotid gland surgery with the VITOM 3D system are promising, further evidence is needed to ensure its efficacy compared to the operating microscope.…”

“…Through the analysis of records and subsequent fulltext screening of the articles, we excluded all the studies that did not match the inclusion criteria (n = 156). The remaining 22 papers were included in a qualitative synthesis for data extraction [1,2,4,5,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Moreover, according to the criteria established for meta-analysis, a quantitative analysis was not performed.…”

“…We included 22 studies in the analysis [1,2,4,5,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. According to the study design, we identified 5 papers as case reports [16,20,22,29,31], 2 papers as case series [15,24], 10 papers as prospective controlled studies [2,4,5,14,17,23,25,27,28,30], and 5 studies as retrospective studies [1,18,19,21,26]. The studies' sample sizes ranged from 1 to 71 participants.…”

“…The patients' average age was 54 ± 16.41 years, ranging from 11 to 82 years old. The major surgical procedures performed were otomastoid and skull base surgery in 101 cases (33.33%) [1,[14][15][16][17][18][19], salivary gland surgery in 95 cases (31.35%) [4,[26][27][28][29], nasal and paranasal surgery in 31 cases (10.23%) [19][20][21][22]. In addition, laryngeal surgery was executed with an exoscopic approach in 28 cases (9.24%) [2,23,24].…”

“…This system is suspended above the surgical field with a manually actuated articulating holder or robotic arm, which transmits a twodimensional (2D) or 3D image to a high-resolution monitor placed at eye level directly across from the surgeon. Magnification power of 8-30 is possible through the 3D camera, while the depth of field ranges from 7 to 44 mm, with a focal distance of 20-50 cm, allowing the surgical field to be observed and illuminated at various distances from the patient [2][3][4][5]. The 3D exoscope provides surgeons with a feasible and potentially excellent alternative to traditional operating microscopes and endoscopes in head and neck surgery.…”