The Impact of the Transcanal Endoscopic Approach and Mastoid Preservation on Recurrence of Primary Acquired Attic Cholesteatoma

Presutti, Livio; Anschuetz, Lukas; Rubini, Alessia; Ruberto, Marco; Alicandri‐Ciufelli, Matteo; Demattè, Marco; Caversaccio, Marco; Marchioni, Daniele

doi:10.1097/mao.0000000000001712

Cited by 43 publications

(24 citation statements)

References 17 publications

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“…A systematic approach to expose these key areas is the main goal of cholesteatoma surgery. 8,9 However, there needs to be an exclusive grading system to measure the exposure in every case of middle ear surgery. Only then it will be possible to compare two techniques.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

et al. 2019

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Objectives To compare endoscopic transcanal approach to attic cholesteatoma with conventional microscopic transcanal technique Methods Seventy‐eight patients diagnosed with attic cholesteatoma were randomly assigned into two groups—one undergoing endoscopic approach and the other microscopic technique. The two groups were compared in terms of area of exposure, access to hidden areas in terms of Middle Ear Structural Visibility Index (MESVI), intraoperative time, postoperative pain, vertigo, long‐term hearing, and surgical outcomes. Results The mean area of exposure in endoscopic atticotomy required was less than that in microscopic group and was found to be statistically significant. The median MESVI for endoscopic group better than that for microscopic group (P < .0001). The mean operating time in endoscopic approach was less than that in case of microscopic approach, with P < .05. The median postoperative pain score in the endoscopic group was less than that in microscopic group (P < .05). No significant difference was found between two groups in terms of vertigo experienced at the end of first week and air‐bone gap closure. When long‐term surgical outcomes were assessed at 1 year, in endoscopic group, one patient had disease recurrence, one cartilage displacement, one perforation, and two had retraction pocket formation. In the microscopic group, two patients had recurrence, four cartilage displacement, one perforation, and five retraction pocket formation. Conclusion Endoscopic management of limited attic cholesteatoma has definite advantages over the conventional microscopic approach. Level of Evidence 1 Laryngoscope, 130:2461–2466, 2020

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Section: Discussionmentioning

confidence: 99%

Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

et al. 2019

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“…These technical refinements allow the surgeon to treat middle-ear pathologies adopting a minimally invasive transcanal approach without skin incision or removal of bone for access purposes. The clinical efficacy of the endoscopic technique compared to the standard microscopic technique has previously been shown in various fields of middle ear surgery like type I tympanoplasties [4], cholesteatoma [5] and stapes surgery, especially in stapes-malformation cases [6].…”

Section: Introductionmentioning

confidence: 99%

Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques

et al. 2019

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Background Endoscopic ear surgery is gaining increasing popularity and has an important impact on teaching middle ear anatomy and basic surgical skills among residents and fellows. Due to the wide-angled views offered, the approach significantly differs from the established microscopic technique. This randomized study compares the acquisition of basic ear-surgery skills using the endoscopic and microscopic technique under standardized conditions. We aim to investigate the required surgical times, attempts and accidental damages to surrounding structures (errors) in surgeons with different training levels. Methods Final-year medical students (n = 9), residents (n = 14) and consultants (n = 10) from the Department of Otorhinolaryngology, Head and Neck Surgery at the University Hospital of Bern, Switzerland were enrolled in the present study. After randomization every participant had to complete a standard set of grasping and dissecting surgical tasks in a temporal bone model. After the first session the participants were crossed over to the other technique. Results Time required for completion of the surgical tasks was similar for both techniques, but highly dependent on the training status. A significant increase in the number of damages to the ossicular chain was observed with the microscopic as compared to the endoscopic technique (p < 0.001). Moreover, students beginning with the endoscopic technique showed an overall significantly lower amount of time to complete the tasks (p = 0.04). From the subjective feedback a preference towards the endoscopic technique mainly in medical students was observed. Conclusions The endoscopic approach is useful and beneficial for teaching basic surgical skills, mainly by providing a reduction of damage to surrounding tissues with similar operating times for both techniques. Moreover, medical students performed significantly faster, when first taught in the endoscopic technique. Especially for young surgeons without previous training in ear surgery, the endoscope should be considered to improve surgical skills in the middle ear.

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“…ndoscopic ear surgery (EES) is gaining popularity among ear surgeons because it permits minimally invasive and functional surgery. Advantages of the endoscopic technique include (1) panoramic views of middle ear anatomy, 1 especially of the retrotympanum and hypotympanum [2][3][4] ; (2) enhanced magnification of very small anatomic structures, such as, a malformed stapes 5 ; (3) the possibility to use angled endoscopes 6 ; (4) preservation of healthy mastoid and middle ear mucosa 7 ; and (5) possible shorter operating times. 8 However, the endoscopic technique has its inherent challenges: (1) because it is a 1-handed technique, the learning curve is deemed to be slower and management of bleeding may be challenging, 9 (2) the narrow space available in the external auditory canal (EAC) limits the movements of surgical instruments, (3) disease inside the mastoid may not be addressed, and (4) until recently, high-definition camera systems were exclusively 2-dimensional (2D).…”

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confidence: 99%

Comparison of 3- vs 2-Dimensional Endoscopy Using Eye Tracking and Assessment of Cognitive Load Among Surgeons Performing Endoscopic Ear Surgery

Anschuetz

Niederhauser

Wimmer

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Endoscopic ear surgery (EES) is an emerging technique to treat middle ear diseases; however, the interventions are performed in 2-dimensional (2D) endoscopic views, which do not provide depth perception. Recent technical developments now allow the application of 3-dimensional (3D) endoscopy in EES. OBJECTIVE To investigate the usability, advantages, and disadvantages of 3D vs 2D endoscopy in EES under standardized conditions. DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted at a tertiary academic medical center in Bern, Switzerland, included 16 residents and consultants of the

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The Impact of the Transcanal Endoscopic Approach and Mastoid Preservation on Recurrence of Primary Acquired Attic Cholesteatoma

Abstract: Transcanal endoscopic approaches that preserve the mastoid may play an important role in preventing recurrence and underscores the importance of the mucosa and mastoid air cells on middle ear homeostasis.

Cited by 43 publications

References 17 publications

Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques

Comparison of 3- vs 2-Dimensional Endoscopy Using Eye Tracking and Assessment of Cognitive Load Among Surgeons Performing Endoscopic Ear Surgery

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