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Lou Z, Lou Z, Lv T, Chen Z. Effects of no perforation margin trimming and EAC packing in cartilage underlay myringoplasty for chronic large perforations in children. Int J Pediatr Otorhinolaryngol 2024; 180:111956. [PMID: 38657426 DOI: 10.1016/j.ijporl.2024.111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/17/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Trimming of perforation margins and external auditory canal (EAC) packing are basic procedures in underlay myringoplasty for repairing chronic perforations. The objective of this study was to compare the operation time, graft outcome, hearing improvement, and complications of endoscopic cartilage underlay myringoplasty with and without trimming of perforation margins and EAC packing in children. STUDY DESIGN Prospective, randomized study. SETTING Tertiary referral center. MATERIAL AND METHODS Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups: myringoplasty with trimming of perforation margin and EAC packing (TPME) group or no trimming of perforation margin and EAC packing (NTPME) group. The operation time, graft success rate, hearing improvement, and complications were compared between the two groups. RESULTS Fifty-two patients were ultimately included in the study. The mean operation time was 31.4 ± 4.2 min in the TPME group and 23.6 ± 1.7 min in the NTPME group; the difference was significant (P < 0.01). The rate of aural fullness significantly differed between the TPME and NTPME groups (P = 0.000). All participants were followed up for 12 months; the graft success rate did not significantly differ between the groups (88.5% vs. 96.2%; P = 0.603). No patients developed adhesive otitis media. Between the preoperative and postoperative measurements, the mean air-bone gap improved by 10.2 ± 2.8 dB in the TPME group and 11.6 ± 0.7 dB in the NTPME group; this was significant (P < 0.001) in both groups. CONCLUSIONS Endoscopic cartilage underlay myringoplasty NTPME shorted the operation time and avoided aural fullness and EAC discomfort compared with the TPME technique; however, graft success and hearing improvement were comparable between the two techniques for repairing large perforations in children.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology,Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233, Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233, Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing,Yishan Road 600, 200233, Shanghai, China
| | - Tian Lv
- Department of Otorhinolaryngology,Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233, Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233, Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing,Yishan Road 600, 200233, Shanghai, China.
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Kawale M, Landge S, Garg D, Kanani K. Endoscopic Versus Microscopic Type 1 Tympanoplasty (Myringoplasty) in a Rural Tertiary Care Hospital in India: A Retrospective Comparative Study. Cureus 2023; 15:e36109. [PMID: 37065312 PMCID: PMC10101192 DOI: 10.7759/cureus.36109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/13/2023] [Indexed: 03/15/2023] Open
Abstract
Background Chronic suppurative otitis media (CSOM) is described as middle ear cleft inflammation that results in long-term alterations to the tympanic membrane and/or the middle ear structures. In cases of CSOM, type 1 tympanoplasty, also known as myringoplasty, is a successful procedure for repairing the tympanic membrane and can even help restore hearing loss. This study aims to compare functional and clinical outcomes of type 1 tympanoplasty performed using transcanal endoscopic ear surgery (TEES) versus those performed via microscopic ear surgery (MES) for perforation in the tympanic membrane in the safe type of CSOM. Methodology Between January 2018 and January 2022, a retrospective analysis of 100 patients (47 men and 53 women) operated for the safe type of CSOM with a perforated tympanic membrane was conducted in our department. Based on the surgical methods, cases were randomly divided into two groups. There were 50 people in group 1 who underwent endoscopic tympanoplasty and 50 in group 2 who underwent microscopic tympanoplasty. The following factors were assessed: patient demographics; tympanic membrane perforation size at the time of surgery; operating room time; hearing outcomes, that is, closure of air-bone gap (ABG); graft uptake success rate; postoperative hospital stay; and medical resource usage. Patients were followed up for 12 weeks. Results Both groups shared similar epidemiological profiles, preoperative hearing status, and perforation sizes. In both groups, the rate of graft uptake was comparable. The average ABG closure was also quite comparable. In the case of endoscopic surgeries, the mean operative time was shorter; which was statistically significant, and complications were significantly lower in group 1. Conclusions Compared to its microscopic counterpart, endoscopic tympanoplasty has a similar graft uptake success rate and a comparable hearing outcome; however, it requires less operative time and hospital stay, has early recovery, and makes lesser use of medical resources, and it is cosmetically better.
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James AL, Papsin BC. Endoscopic Repair of Round Window Cochleocele. Otol Neurotol 2022; 43:e1136-e1139. [PMID: 36156534 DOI: 10.1097/mao.0000000000003695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the novel presentation, implications, and endoscopic management of a congenital round window cochleocele. PATIENT A 16-month old girl with profound hearing loss from bilateral incomplete partition type 1 (IP1) anomaly of the cochlea plus left-sided cochlear nerve aplasia and cochleocele. INTERVENTION Anomalies were identified with computed tomographic scanning and magnetic resonance imaging during cochlear implant candidacy assessment. While under general anesthesia for right-sided cochlear implantation, the cochleocele was removed and packed with temporalis fascia using transcanal endoscopic ear surgery. The endoscope was held by an assistant while the surgeon packed the round window using a two-handed technique to counter the gush of cerebrospinal fluid. RESULTS The child made an uneventful recovery with no cerebrospinal fluid leak or meningitis. CONCLUSIONS Cochleocele can protrude through the round window of a cochlea with incomplete partition type 1 anomaly. An increased risk of meningitis secondary to acute otitis media is expected given the known risk from cochleocele arising through a stapes footplate fistula. Care should be taken to check for the presence of a cochleocele in hearing loss from congenital malformations involving the basal turn of the cochlea on imaging and also at the time of cochlear implant surgery. Repair should be considered at the first opportunity to prevent meningitis. If early cochlear implant surgery is not feasible or appropriate (as, for example, with cochlear nerve aplasia), transcanal endoscopic ear surgery provides good access for a low-morbidity approach.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Nassif N, Sorrentino T, Losito MT, Zorzi S, Redaelli de Zinis LO. Endoscopic transcanal tympanoplasty type I in children: Evolving experience in tragus perichondrium vs. acellular porcine small intestinal sub-mucosa grafts. Int J Pediatr Otorhinolaryngol 2022; 160:111245. [PMID: 35870255 DOI: 10.1016/j.ijporl.2022.111245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endoscopic trans-canal tympanoplasty type I (ETT) is gradually diffusing worldwide. It mainly allows less invasive surgery in children with respect to a microscope approach by avoiding post-auricular access. The aim of this study is to illustrate our experience in endoscopic reconstruction of tympanic membrane, using autologous tragus perichondrium (TP) and non-autologous acellular porcine small intestinal sub-mucosa (SIS) as grafts. METHODS Between January 2011 and December 2020, the results of a prospective non-randomized series of consecutive ETT were analyzed. The primary outcome was closure rate at 6 months and secondary outcomes are closure rates associated with age, size of perforation, type of perforation and middle ear status, presence of myringosclerosis, type of graft, status of contralateral ear, adenoidectomy and pre-postoperative ABG change. Statistical analysis was performed using the SPSS statistical package. RESULTS One hundred and sixteen consecutive procedures, mean age 9.4 years (range 4-17 years), were evaluated. TP and SIS grafts were used in 65 (56%) and 51 (44%) procedures, respectively. Mean duration of surgical procedure was 53 ± 21 min for SIS and 77 ± 18 min for TP (P = 0.001) Total graft intake was 82.8%; TP and SIS intake were 86.2% and 78.4% (P = 0.3), respectively. Graft intake w.r.t. in age stratified age groups was not statistically significant. Average preoperative and postoperative air-bone gap was 12.1 ± 7.6 dB and 5.5 ± 3.8 dB, respectively (P = 0.001). The difference in closure rates was not significant. Neither intra- nor postoperative complications were observed. CONCLUSIONS In children, ETT is an applicable and less invasive technique compared to the microscope and offers less morbidity. The use of SIS contributes additional less invasiveness to endoscopic surgery by avoiding tragus harvesting with a comparable success rate and granting significantly less surgical duration.
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Affiliation(s)
- Nader Nassif
- Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Italy.
| | - Tommaso Sorrentino
- Department of Otolaryngology Head and Neck Surgery, "ASST Spedali Civili", Italy
| | - Maria Teresa Losito
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Silvia Zorzi
- Department of Otolaryngology Head and Neck Surgery, "ASST Spedali Civili", Italy
| | - Luca Oscar Redaelli de Zinis
- Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Review of Transcanal Endoscopic Ear Surgery (TEES) and Bioengineering for Pediatric Otologic Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Tissue engineering and regenerative medicine strategies for the repair of tympanic membrane perforations. BIOMATERIALS AND BIOSYSTEMS 2022; 6:100046. [PMID: 36824158 PMCID: PMC9934438 DOI: 10.1016/j.bbiosy.2022.100046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the high success rate of autologous grafts in tympanic membrane repair, clinical alternatives are required for the closure of unresponsive chronic perforations that can lead to recurring infection and hearing loss. Tissue engineering and regenerative medicine approaches have emerged as another strategy to repair the eardrum, in addition to negating the need for donor tissue harvest and related surgical iatrogenicities. This review highlights the main approaches using biomaterials, growth factors, and cell therapies towards the healing of complex TM perforations. In addition, we discuss the challenges and advances for the development of reliable animal models, which will allow the optimisation and development of novel techniques. Finally, we indicate technologies that are currently used clinically and others that are closer to the market. The advances here discussed on tissue engineering and regenerative medicine strategies applied to the field of TM perforations will allow otologists, surgeons, and researchers to better bring novel technologies to the bedside as well as to develop new ones.
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Outcomes following tympanoplasty surgery using porcine derived small intestinal submucosa (SIS). The Journal of Laryngology & Otology 2021; 136:304-308. [PMID: 34819189 DOI: 10.1017/s0022215121003716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Veleur M, Lahlou G, Torres R, Daoudi H, Mosnier I, Ferrary E, Sterkers O, Nguyen Y. Robot-Assisted Middle Ear Endoscopic Surgery: Preliminary Results on 37 Patients. Front Surg 2021; 8:740935. [PMID: 34692763 PMCID: PMC8527038 DOI: 10.3389/fsurg.2021.740935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Endoscopy during middle ear surgery is advantageous for better exploration of middle ear structures. However, using an endoscope has some weaknesses as surgical gestures are performed with one hand. This may trouble surgeons accustomed to using two-handed surgery, and may affect accuracy. A robot-based holder may combine the benefits from endoscopic exposure with a two-handed technique. The purpose of this study was to assess the safety and value of an endoscope held by a teleoperated system. Patients and Methods: A case series of 37 consecutive patients operated using endoscopic exposure with robot-based assistance was analyzed retrospectively. The RobOtol® system (Collin, France) was teleoperated as an endoscope holder in combination with a microscope. The following data were collected: patient characteristics, etiology, procedure type, complications, mean air and bone conduction thresholds, and speech performance at 3 months postoperatively. Patients had type I (myringoplasty), II (partial ossiculoplasty), and III (total ossiculoplasty) tympanoplasties in 15, 14, and 4 cases, respectively. Three patients had partial petrosectomies for cholesteatomas extending to the petrous apex. Finally, one case underwent resection of a tympanic paraganglioma. Ambulatory procedures were performed in 25 of the 37 patients (68%). Results: Complete healing with no perforation of the tympanic membrane was noted postoperatively in all patients. No complications relating to robotic manipulation occurred during surgery or postoperatively. The mean air conduction gain was 3.8 ± 12.6 dB for type I (n = 15), 7.9 ± 11.4 dB for type II (n = 14), and −0.9 ± 10.8 for type III tympanoplasties (n = 4), and the postoperative air-bone conduction gap was 13.8 ± 13.3 dB for type I, 19.7 ± 11.7 dB for type II and 31.6 ± 13.0 dB for type III tympanoplasty. They was no relapse of cholesteatoma or paraganglioma during the short follow-up period (<1 year). Conclusion: This study indicates that robot-assisted endoscopy is a safe and trustworthy tool for several categories of middle ear procedures. It combines the benefits of endoscopic exposure with a two-handed technique in middle ear surgery. It can be used as a standalone tool for pathology limited to the middle ear cleft or in combination with a microscope in lesions extending to the mastoid or petrous apex.
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Affiliation(s)
- Marine Veleur
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France
| | - Ghizlene Lahlou
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Renato Torres
- Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Hannah Daoudi
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France
| | - Isabelle Mosnier
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Evelyne Ferrary
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Olivier Sterkers
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Yann Nguyen
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
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James AL. Totally endoscopic tympanic membrane repair. HNO 2021; 69:791-796. [PMID: 34041565 DOI: 10.1007/s00106-021-01052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transcanal totally endoscopic ear surgery (TEES) has become increasingly popular internationally; however, for surgeons trained with a two-handed microscope-guided approach, the potential challenges of adopting TEES can appear off-putting. OBJECTIVES This article outlines the pros and cons of TEES for tympanic membrane repair and describes aspects of surgical technique relevant to those who might adopt this approach. MATERIALS AND METHODS Data are provided from the author's experience along with a review of relevant literature, including several meta-analyses of tympanoplasty outcome. RESULTS Meta-analyses show that TEES tympanoplasty is as effective at closing tympanic membrane perforations and improving hearing as microscope-guided surgery. Yet patients benefit from avoidance of a skin incision and faster recovery. CONCLUSION Repair of the tympanic membrane with TEES is feasible and effective. This minimally invasive approach is very appealing to patients.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
- Department of Otolaryngology, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada.
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Li B, Zhou L, Wang M, Wang Y, Zou J. Endoscopic versus microscopic surgery for treatment of middle ear cholesteatoma: A systematic review and meta-analysis. Am J Otolaryngol 2021; 42:102451. [PMID: 33360773 DOI: 10.1016/j.amjoto.2020.102451] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/27/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Endoscopic ear surgery (EES) is minimally invasive and increasingly used to treat middle ear disease. In this meta-analysis, we compared the efficacies of EES and microscopic ear surgery (MES) in patients with middle ear cholesteatoma. METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies that reported the comparative surgical outcomes of EES and MES in patients with middle ear cholesteatoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. All included studies involved ≥1 of the following outcomes: recurrence of or residual disease, graft intake success rate, audiological performance, and operation time. We calculated the pooled relative risk (RR) or weighted mean difference with 95% confidence intervals (CIs) by using STATA software. RESULTS Thirteen studies were included in the quantitative meta-analysis. The pooled recurrence and residual rates of cholesteatoma were significantly lower in the EES group than in the MES group [RR: 0.51, 95%CI: 0.31-0.84, heterogeneity (I2) = 4.7%; P = .394; RR: 0.68; 95%CI: 0.47-0.99; I2 = 0.0%; P = .878; respectively]. There were no significant differences in other parameters, such as graft intake success rates, audiological performance, and operation times, between the 2 groups. CONCLUSION The pooled results showed that EES reduced the residual lesion rate and postoperative recurrence risk in patients with middle ear cholesteatoma. However, there was insufficient evidence to prove that EES was advantageous in graft intake success rate auditory performance, and operation time.
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Abstract
Herein we provide a broad overview of the literature as it applies to endoscopic myringoplasty and type I tympanoplasty. Advantages and disadvantages of the endoscopic approach are reviewed for both the adult and pediatric populations and are compared with conventional microscopic techniques.
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Affiliation(s)
- Zachary G Schwam
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Maura K Cosetti
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report. Eur Arch Otorhinolaryngol 2020; 278:77-85. [PMID: 32458123 DOI: 10.1007/s00405-020-06070-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Middle ear surgery may benefit from robot-based assistance to hold micro-instruments or an endoscope. However, the surgical gesture performed by one hand may perturb surgeons accustomed to two-handed surgery. A robot-based holder may combine the benefits from endoscopic exposure and a two-handed technique. Furthermore, tremor suppression and accurate tool control might help the surgeon during critical surgical steps. The goal of this work was to study the safety of an otological robot-based assistant under clinical conditions in a limited series of patients. METHODS The RobOtol system has been used as an endoscope or a micro instrument holder for this series. Eleven cases were operated on with the robot as an endoscope holder for chronic otitis. Twenty-one cases were operated on with the robot as a micro-instrument holder for otosclerosis (9 cases), transtympanic tube placement (2 cases), or cochlear implantation (10 cases). RESULTS No complications related to the robot manipulation occurred during surgery nor in postoperative. In the chronic otitis group, all perforations were sealed and 3-month postoperative pure-tone average air-bone gap (PTA ABG) was 15 ± 2.6 dB. In the otosclerosis group, 1-month post-op PTA ABG was 10 ± 1 dB. For cochlear implantation cases, a scala tympani insertion, a vestibular scala translocation occurred and a full scala vestibuli insertion was observed in 7, 2 and 1 case, respectively. CONCLUSION The RobOtol system has reached the clinical stage. It could be used safely and with accurate control as an endoscope holder or a micro instrument holder in 32 cases.
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Dursun E, Demir E, Terzi S, Erdivanlı ÖÇ, Coşkun ZÖ, Balaban GA, Çeliker M. Endoscopic type 1 cartilage tympanoplasty in children. Int J Pediatr Otorhinolaryngol 2020; 131:109854. [PMID: 31918245 DOI: 10.1016/j.ijporl.2019.109854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Endoscopic type 1 tympanoplasty using cartilage grafts for repair of chronic tympanic membrane perforation is increasing. The aim of this study was to evaluate the results of endoscopic type 1 cartilage tympanoplasty in children. MATERIALS AND METHODS Patients under 18 years of age who underwent type 1 cartilage tympanoplasty between January 2013 and February 2019 were retrospectively evaluated. Anatomic success rate was calculated according to the intact status of the graft. Air conduction (AC), bone conduction (BC), air-bone gap (ABG) and hearing gain were calculated using pure tone audiometry tests at pre-operative, and 6th month postoperative period. Patients with postoperative ABG ≤20 dB were considered as functionally successful. RESULTS The study included 56 patients (6 bilateral) and 62 ears. The anatomic success rate of our study was 91.9% (57/62). Preoperative AC was 36.4 ± 6.5 (21-50) dB, BC was 7.8 ± 3.7 (5-25) dB, and ABG was 28.6 ± 6.9 (10-41) dB. Postoperative AC was 24.5 ± 8.8 (7-45) dB, BC was 7.6 ± 3.4 (5-19) dB, and ABG was 16.9 ± 7.4 (2-32) dB. There was no change in postoperative BC (p: 0.683), whereas AC, and ABG significantly decreased (p < 0.001). Mean hearing gain was 12.1 ± 6.2 (3-26) dB and the functional success rate was 72.5% (45/62). CONCLUSION Endoscopic type 1 cartilage tympanoplasty, a minimally invasive surgical procedure, provided successful functional and anatomical results at the pediatric population.
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Affiliation(s)
- Engin Dursun
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Emine Demir
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey.
| | - Suat Terzi
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Özlem Çelebi Erdivanlı
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Zerrin Özergin Coşkun
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Gökçe Aydın Balaban
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Metin Çeliker
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
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Endoscopic approach to the round window through posterior tympanotomy for cochlear implantation in children: A study on feasibility. Int J Pediatr Otorhinolaryngol 2020; 129:109781. [PMID: 31756660 DOI: 10.1016/j.ijporl.2019.109781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of rigid endoscopy through posterior tympanotomy, which provides both a view of the round window and direction of the scala tympani in children. METHODS After a standard mini-invasive surgical approach with postauricular access and transmastoid posterior tympanotomy of 2 mm, a 0°, 1.9 mm diameter and 11 cm long endoscope is positioned in proximity of the upper part of the posterior tympanotomy to obtain a panoramic view of the inferior part of the medial wall of the tympanic cavity. Surgical complications and changes in hearing threshold were analyzed. RESULTS Eight children were submitted to cochlear implantation with endoscopic assistance through posterior tympanotomy. Complete visualization of the round window niche was possible in every ear. No complications related to the procedure were observed. Preoperative threshold was preserved in 9 of 10 ears. CONCLUSIONS Direct endoscopic view through the posterior tympanotomy allows visualization of the entire round window niche as well as the angle of introduction of the multi-electrode array along the direction of the scala tympani.
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Lee SY, Lee DY, Seo Y, Kim YH. Can Endoscopic Tympanoplasty Be a Good Alternative to Microscopic Tympanoplasty? A Systematic Review and Meta-Analysis. Clin Exp Otorhinolaryngol 2019; 12:145-155. [PMID: 30674106 PMCID: PMC6453785 DOI: 10.21053/ceo.2018.01277] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
Although efficacies and proportions of tympanoplasty performed via endoscopic ear surgery (EES) have gradually introduced, it remains unclear whether total EES is a good alternative to microscopic ear surgery (MES). Herein, we aimed to compare therapeutic effects of EES and MES in patients receiving tympanoplasty or myringoplasty. A search of MEDLINE, PubMed, and Embase databases was conducted to compare the efficacies of EES and MES. Two investigators independently reviewed all studies and extracted data with a standardized form. We assessed risk of bias and calculated pooled odds ratio (OR) estimates with a 95% confidence interval (CI). Thirteen studies (607 EES patients and 678 MES patients) met inclusion criteria for quantitative meta-analysis. In pooled analysis, those who undergo EES have 0.99 times the OR of graft success compared to those with MES (95% CI, 0.84 to 1.16; P=0.894). In qualitative analysis, comparable hearing improvement was observed between the two groups, despite inconsistent audiometric evaluation. The air-bone gaps (ABGs) improved 2.02 dB less in EES than in MES (mean difference of improvements of ABGs, 2.02; 95% CI, –3.84 to –0.20; P=0.029); however, substantial heterogeneity and publication bias limited the integrity of this analysis. Further, EES significantly decreased canalplasty rate, wound complications, and operation time, compared to MES. Moreover, patients receiving EES reported higher cosmetic satisfaction than patients receiving MES. EES can be a good alternative to MES in terms of comparable graft success rate and hearing outcomes in patients receiving tympanoplasty or myringoplasty. Moreover, EES was less invasive, resulting in higher cosmetic satisfaction, reduced morbidity, and shorter operation time. Our results may affect decision-making and outcome prediction in cases of EES; however, confirmation is needed to clarify potential bias.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yuju Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Han SY, Lee DY, Chung J, Kim YH. Comparison of endoscopic and microscopic ear surgery in pediatric patients: A meta-analysis. Laryngoscope 2018; 129:1444-1452. [PMID: 30593662 DOI: 10.1002/lary.27556] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Recently, the endoscope has been increasingly introduced for middle-ear surgery. To evaluate the postoperative outcomes of endoscopic ear surgery (EES) in pediatric patients, we did a qualitative analysis with a systematic review and quantitative analysis with meta-analysis of available literature. METHODS Studies reporting the comparative surgical outcomes of EES in pediatric patients were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases from database inception through 2017. The selected articles included clinical studies conducted with at least 30 subjects and at least one postoperative parameter, including residual or recurrent cholesteatoma and graft success in tympanoplasty. Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta-analysis was performed using a random-effects model and qualitative review was performed on the smaller studies. RESULTS Ten studies were identified as appropriate for quantitative meta-analysis and 19 studies for qualitative analysis. In the meta-analysis, residual or recurrence rate of cholesteatoma was significantly lower in the EES group than in the microscopic ear surgery (MES) group (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.38-0.84, P = .005). The graft success rate of tympanoplasty was not statistically different between EES and MES groups (OR: 0.72, 95% CI: 0.41-1.26, P = .249). In the qualitative analysis, most of the studies reported similar audiological outcomes after tympanoplasty and success rate of cholesteatoma removal between the two groups. CONCLUSIONS It appears that EES reduces the risk of residual cholesteatoma in children and that the success of perforation closure is equivalent to MES. Laryngoscope, 129:1444-1452, 2019.
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Affiliation(s)
- Sang-Yoon Han
- the Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Doh Young Lee
- the Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Juyong Chung
- the Department of Otolaryngology-Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Ho Kim
- the Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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The Current Limitations and Future Direction of Instrument Design for Totally Endoscopic Ear Surgery: a Needs Analysis Survey. Otol Neurotol 2018; 39:778-784. [DOI: 10.1097/mao.0000000000001802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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