3D-4K exoscope-assisted temporal bone dissection: a new frontier in surgical training

Does the visual system affect the learning curve of the Otosurgeon? A cadaveric study comparing microscopy vs exoscopy

PURPOSE

Optical magnification is crucial in ear surgery, ensuring the precise identification of anatomical structures. Traditionally, microscopes have been the standard due to their magnification and stereoscopic capabilities. However, the introduction of exoscopes has introduced new possibilities, particularly in ergonomics, teaching, collaboration, and surgical training. This cadaveric study aimed to evaluate the feasibility, effectiveness, and trainee performance when using the exoscope in ear dissection and to compare it with the traditional microscope.

METHODS

This study involved 10 non-expert medical trainees who undertook a series of surgical tasks on cadaveric specimens using both the microscope and exoscope. The tasks included different surgical approach simulations and exercises. NASA Task Load Index and a Visual Analog Scale questionnaires were administered to assess participants' subjective experiences with each instrument.

RESULTS

All participants successfully completed the assigned tasks with both the microscope and exoscope. While there were no significant differences in the timing of surgical steps between the two instruments, participants perceived the microscope as less physically demanding and temporally taxing, while the exoscope excelled in structural identification and offered benefits for teaching and collaboration.

CONCLUSIONS

The choice between microscope and exoscope should be guided by the specific surgical demands, educational context, and preferences of the team. While the microscope excels in flexibility, the exoscope provides advantages in structural identification and collaborative learning, making it a valuable tool in ear surgery. This study contributes valuable insights for otological surgeons and educators to optimize surgical outcomes and learning experiences of trainees.

3D 4K Exo-Endoscopic Temporal Bone Dissection: A Novel Approach for Sharing the Anatomy

BACKGROUND

Temporal bone dissection is overwide recognized as an ideal training method for otologic surgeons. The knowledge of temporal bone anatomy and especially of the course of infratemporal facial nerve is pivotal in practice. The 3D exoscope is an innovative and promising tool, that was recently introduced in ear surgery.

METHODS

A high-definition 3D exoscope (3D VITOM®) mounted on the VERSACRANETM holding system (Karl Storz) was used to perform two temporal bone dissection, with the aim to study the anatomy of infratemporal facial nerve. The 3D endoscope (TIPCAM®1 S 3D ORL, Karl Storz) was used in combination to provide a close-up high-quality view and to provide a different angle of view on fine anatomical relationships.

RESULTS

The high-definition 3D exoscope allowed to conduct the dissection with high quality visualization and to share the same surgical field with trainees. Moreover, it showed a high interchangeability with the 3D endoscope.

CONCLUSIONS

3D 4 K Exo-endoscopic temporal bone dissection seems to have benefits in terms of educational purpose, especially concerning anatomy understanding. The superiority in teaching value of this tool should be further investigated in cohort studies.

Exoscope-assisted surgery in otology and neurotology

PURPOSE OF REVIEW

This review addresses the pressing need for an updated understanding of high-definition 3D exoscope role in contemporary otologic and neurotologic practice. With technological advancements driving innovations in surgical visualization, it is crucial to evaluate the efficacy of exoscope-assisted surgery compared to traditional microscopic approaches. By synthesizing recent literature, this review offers insights into the current state of exoscopic ear and lateral skull base surgery and its implications for clinical practice and research.

RECENT FINDINGS

Recent literature has focused on several key themes. Firstly, studies have demonstrated the feasibility and safety of exoscopic approaches for various otologic and neurotologic procedures. Secondly, comparative studies have highlighted similar outcomes with exoscopic techniques compared to conventional microscopic surgery, particularly in terms of operative time and complication rates. Thirdly, the exoscope can be a valuable tool for the education and training of surgeons.

SUMMARY

The findings from recent literature underscore the growing significance of exoscope-assisted surgery in otology and lateral skull base practice. However, challenges such as high magnification image quality and learning curve must be addressed to optimize its widespread adoption. Overall, this review highlights the importance of continued research and innovation in this rapidly evolving field.

Comparison between the high-definition 3D exoscope and the operating microscope in head and neck reconstruction

The purpose of this study was to compare the three-dimensional (3D) operating exoscope (OE) with the conventional operating microscope (OM) in head and neck reconstruction. A retrospective cohort study was performed including 50 consecutive patients with no history of previous surgery or irradiation (32 male, 18 female; mean age 59.2 ± 13.3 years), who underwent free flap head and neck reconstruction using a 3D OE (n = 25; OE group) or conventional OM (n = 25; OM group). The mean total operative time was 8.0 ± 1.53 h in the OE group and 7.6 ± 1.52 h in the OM group (P = 0.86). The median (interquartile range) anastomosis time was 78.0 (63.0-91.5) minutes in the OE group and 90.0 (75.5-115.0) minutes in the OM group (P = 0.06). The final free flap survival rate was 100%. Only seven patients experienced a free flap reconstruction-related complication, and they were similarly distributed between the two groups (four in the OE group, three in the OM group; P = 0.68). Secondary outcomes (length of hospital stay, tracheostomy dependence, feeding tube dependence) were comparable in the two groups (P > 0.05). The 3D OE is a viable alternative to the conventional OM for performing standard head and neck free flap reconstructive procedures.

High-Definition 3D Exoscope in Pediatric Otorhinolaryngology: A Systematic Literature Review

This PRISMA-compliant systematic review aimed to investigate the use of and the most common procedures performed with the novel 3D 4K exoscope in surgical pediatric head and neck settings.

METHODS

Search criteria were applied to PubMed, EMBASE and the Cochrane Review databases and included all studies published up to January 2023 reporting 3D 4K exoscope-assisted surgeries in pediatric patients. After the removal of duplicates, selection of abstracts and full-text articles, and quality assessment, we reviewed eligible articles for number of patients treated, age, surgical procedures, and outcomes.

RESULTS

Among 54 potentially relevant records, 5 studies were considered eligible and included in this systematic review, with reported treatment data for 182 patients. The surgical procedures belong to the otologic field (121 cases), head and neck surgery (25 cases) and transoral surgery (36 cases). Exoscopy allowed high quality visualization of anatomical structures during cochlear implantation and during reconstruction in head and neck surgery; moreover, it improved the surgical view of surgeons, spectators and ENT students.

CONCLUSIONS

The use of 3D 4K exoscopy has shown promising potential as a valuable tool in pediatric ORL-head and neck surgery; nevertheless, further validation of these encouraging outcomes is necessary through larger-scale studies specifically focused on pediatric patients.