Figure - available from: European Archives of Oto-Rhino-Laryngology
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Surgical setting for 3D endoscopic ear surgery on the right side. The surgeon holds the videoscope in the non-dominating hand and uses the surgical instruments with the opposite, as in conventional 2D surgery. Note that the videoscope is not wrapped in a sterile bag. The scrub nurse is alongside the surgeon, looking at the monitor in a straight direction as him. Both are wearing polarizing glasses for 3D view
Source publication
PurposeTo compare 3D to 2D technology in endoscopic ear surgery (EES); to report surgeons’ feedback on the use of 3D in EES; to describe the operative setting for 3D EES.MethodsA case–control study on EES was performed at a tertiary university center. All consecutive cases of 3D EES (case group) were matched to a control group operated with the sta...
Citations
... Demographic data are given in Table 1. The mean follow-up time was similar in both groups: 11.97 ± 4.2 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months in the ES group and 12.06 ± 3.99 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months in the MS group (p = 0.958). ...
... Demographic data are given in Table 1. The mean follow-up time was similar in both groups: 11.97 ± 4.2 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months in the ES group and 12.06 ± 3.99 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months in the MS group (p = 0.958). ...
... They allow only one hand to be used during surgery, the two-dimensional image can be misleading for the surgeon in terms of depth, and it takes time to learn this technique [13,14]. It has been reported that 3D endoscopes are very effective in improving the sense of depth, but the cost of these systems limits their use [15]. Various studies have found that sinonasal endoscopes 4 mm in diameter with a length of 18 cm are easy to use and help maintain wider exposure in the middle ear [16,17]. ...
Purpose
The goal of the present study was to compare the audiologic results, complications, and advantages/disadvantages of endoscopic and microscopic stapedotomy.
Methods
Patients who experienced stapedotomy surgery in the Ear Nose Throat Clinic (ENT) of XXXX University Faculty of Medicine between September 2011 and January 2018 were included in the study. The data of all patients were analyzed and divided into two groups. Those who underwent endoscopic stapedotomy were included in group I, and patients who underwent microscopic stapedotomy formed group II. Surgical findings, complications, and operation times were compared for the two groups. Air and bone conduction thresholds were evaluated at the frequencies of 500, 1000, 2000, and 4000 Hz pre- and postoperatively at 1, 3, and 6 months, and the mean (± SD) air–bone gap value was recorded.
Results
While the mean pre- and postoperative air-bone gaps were 34.38 ± 7.47 dB (23–53 dB) and 9.69 ± 4.43 dB (0–19 dB), respectively, in group I, 34.32 ± 7.57 dB (23–6 dB) and 9.62 ± 4.25 dB (2–23 dB) were the respective means calculated in group II (p < 0.05). When the mean postoperative air–bone gap was compared, there was no statistically significant difference between the two groups (p = 0.774). The mean operative times for groups I and II were 57.22 ± 4.37 min and 63.70 ± 7.34 min, respectively (p < 0.001). The requirement for chorda tympani nerve manipulation and scutum curettage was significantly less in group I compared to group II (p = 0.003). Postoperative dysgeusia and postoperative pain were found to be higher in group II than group I, but they were not statistically significant (p > 0.05).
Conclusion
Endoscopic stapedotomy displayed similar audiological results, shorter operation times, and similar complication rates, as well as being a less invasive surgery, compared to the microscopic approach.
... To address this issue, 3D endoscopes have been developed. In our experience, the use of a 3D endoscope did not change the surgical outcome and relies mostly on the surgeon's preference [22]. Operative time mainly depends on the experience of the operating surgeon. ...
Purpose of Review
Stapes surgery has been established as the gold standard for surgical treatment of conductive hearing loss in otosclerosis. Excellent outcomes with very low complication rate are reported for this surgery. Recent advances to improve surgical outcome have modified the surgical technique with endoscopes, and recent studies report development of robotical assistance. This article reviews the use of endoscopes and robotical assistance for stapes surgery.
Recent Findings
While different robotic models have been developed, 2 models for stapes surgery have been used in the clinical setting. These can be used concomitant to an endoscope or microscope. Endoscopes are used on a regular base regarding stapes surgery with similar outcomes as microscopes. Endoscopic stapes surgery shows similar audiological results to microscopic technique with an advantage of less postoperative dysgeusia and pain. Its utility in cases of revision surgery or malformation is emphasized.
Summary
Endoscopic stapes surgery is used on a regular basis with excellent outcomes similar to the microscopic approach, while reducing surgical morbidity. Robotic technology is increasingly being developed in the experimental setting, and first applications are reported in its clinical use.
... Technical development of endoscopes led to the discovery of 3D endoscope systems used in otologic surgery. 3D endoscopes have the advantages of enhanced depth perception and better spatial orientation [28]. The addition of 3D endoscopic view may help to increase stapes mobilization rate and improve hearing results in TS surgery in near future. ...
Objectives
The objectives of this study are to describe our experiences in endoscopic transcanal management of tympanosclerosis, to explain our surgical approaches to reconstruct the sound conduction system and to analyze the hearing results obtained with our surgical approaches.Study designA retrospective cohort study, using medical records of 28 cases that underwent endoscopic transcanal tympanoplasty surgery due to tympanosclerosis from January 2016 to January 2020.SettingsPrivate otology clinicPatientsTwenty-eight ears of 26 patients were enrolled into study. Patients were grouped according to Wielinga–Kerr classification and only type II, III and IV patients were included in the study.InterventionsExclusively transcanal endoscopic surgery was performed in all cases. Primary goal was to mobilize the affected ossicles by removing the offending TS and reconstruct the ossicular chain. Malleostapediopexy was preferred when attic by-pass procedures were needed. Glass ionemer bone cement was used to reconstruct the ossicular defects.Outcome measuresPreoperative and postoperative pure tone average of air conduction and bone conduction and air–bone gap results were evaluated. Operation was considered successful if postoperative ABG < 20 dB was achieved. Complications and graft take rate were also evaluated.ResultsSingle-staged surgery was performed in 23 of 28 cases (82.1%). Graft take rate was 93%. The mean preoperative ABG significantly decreased from 33.9 ± 5.19 to 12.55 ± 5.52 dB postoperatively for 23 cases who had single-staged surgeries (p < 0.001, Wilcoxon signed rank test) at the end of the mean follow-up period of 23 months. For this group, the mean preoperative AC-PTA significantly improved from 48.64 ± 9.30 to 22.93 ± 7.45 dB (p < 0.001, Wilcoxon signed rank test) postoperatively with a mean PTA improvement of 25.71 ± 6.02 dB. Success criterion was achieved in 22 of 23 cases (95.7%). There was no sensorineural hearing loss, facial nerve paralysis and postoperative vertigo after the surgical procedures. All patients had been discharged within the first 24 h.Conclusions
Surgical treatment of tympanosclerosis is still a controversial issue. Endoscopic surgery seems a safe technique for the management of tympanosclerosis. Single-stage surgery is possible in most of the cases with a satisfactory hearing result. We speculate that addition of endoscopic view may increase the single-stage surgery ratio.
... Further technological devices (such as three-dimensional exoscopes, robotic systems, 4 K magnification and narrow band imaging) were recently applied and assessed in otologic surgery [6][7][8][9][10]. Nowadays, in addition to the traditional white light (WL) endoscopy, different enhancement systems are available for the identification of the superficial subepithelial microvascular pattern. ...
... After performing a final WL recognition of the surgical field with no identification of cholesteatoma, IMAGE1 S allowed the detection of histologically confirmed residuals in 5 out of 45 cases (11%), which would otherwise have been unrecognized by WL only (Fig. 4). Mean follow-up time was 11 months (range: [5][6][7][8][9][10][11][12][13][14]. All patients were evaluated at least three times post-operatively and all turned out negative for cholesteatomatous recurrence. ...
PurposeTo evaluate the role of selected modalities of Storz Professional Image Enhancement System (IMAGE1 S) in differentiating cholesteatoma during endoscopic ear surgery (EES); to assess the potential usefulness of IMAGE1 S in recognition of cholesteatoma residuals at the end of EES.MethodsA retrospective study on 45 consecutive patients who underwent EES for cholesteatoma between March 2019 and November 2019 at a tertiary referral center was performed. For each case, Spectra A and Spectra B filters were applied intra-operatively. When examining the surgical field, a switch from white light (WL) to IMAGE1 S was performed to detect cholesteatoma and differentiate it from non-cholesteatomatous tissue. When the IMAGE1 S pattern was suspicious for the presence of cholesteatoma, images of the field under both enhancement modalities were taken and the targeted lesions were sent for histologic analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IMAGE1 S were calculated. A final recognition of the surgical field using the selected filters was performed to detect any possible cholesteatomatous residuals.ResultsDetection of cholesteatoma by IMAGE1 S selected filters revealed the following data: sensitivity 97%, specificity 95%, PPV 95%, NPV 97%. On three occasions, there was no correspondence between enhanced endoscopy and histology. In 5 out of 45 cases (11%), cholesteatoma residuals, which had not been identified at WL inspection at the end of the procedure, were detected by IMAGE1 S.Conclusion
Our results suggest a potential role for IMAGE1 S Spectra A and B filters in EES for cholesteatoma surgery. We propose the integration of IMAGE1 S as a final overview of the surgical cavity for recognition of cholesteatomatous residuals.
... Indeed, traditional 2D and modern 3D endoscopic techniques have recently been compared for surgeons performing endoscopic ear surgery. 9,19 Here, 3D endoscopy was shown to be suitable for endoscopic ear surgery and to have advantages, especially ...
Objective
Endoscopic ear surgery is gaining popularity as a minimally invasive surgical technique for middle ear diseases. Its ongoing implementation into clinical routine has consequences regarding teaching of middle ear anatomy and surgery. To improve undergraduate and postgraduate training, we investigated the perception of and preference for endoscopy as compared with microscopy at different educational levels.
Study Design
Qualitative study based on a thematic analysis approach.
Setting
Tertiary academic medical center.
Methods
After a standardized curriculum was run on endoscopic and microscopic anatomy and surgical skills education, 5 focus groups were held. The interviews were conducted, video recorded, transcribed, and analyzed. Analysis of the data gave rise to 11 themes showing the participants’ perceptions and preferences.
Results
Five medical students, 11 otorhinolaryngology residents, and 3 staff members participated in this qualitative study. For anatomy teaching, there was a clear preference for the endoscopic technique. The main advantages were the enhanced overview and perception of the anatomic details provided through endoscopy. For skills acquisition, the perceived advantages of the techniques were the same view of the surgical field for endoscopy and the 2-handed surgical technique for microscopy. However, there was no clear preference between the techniques for skills acquisition.
Conclusion
The endoscopic technique was generally judged more beneficial for teaching anatomy, especially due to the greater visualization of the complex middle ear anatomy. Given that both techniques will remain important to future surgeons, the relative unique benefits of each must be considered when designing and optimizing curricula for otologic education.
Objective
Three‐dimensional (3D) endoscopy has been developed to provide depth perception to allow for improved visualisation during otolaryngology surgery. We conducted a systematic review to determine the surgical safety and efficacy of 3D endoscopy in comparison to two‐dimensional (2D) endoscopy in performing otolaryngology procedures, and the role of 3D endoscopy as a training tool for novice otolaryngology surgeons.
Methods
Primary studies were identified through MEDLINE, Embase and Web of Science databases, which were searched for articles published through June 2022 that compared the outcomes of 2D and 3D endoscopy in otolaryngology surgical procedures or otolaryngology‐relevant simulations. Candidate articles were independently reviewed by two authors.
Results
A total of 18 full‐text articles met inclusion criteria for this study. In clinical trials ( n = 8 studies, 362 subjects), there were no significant differences in performance time, intraoperative or postoperative complications with 3D endoscopes when compared to 2D. In simulation studies ( n = 10 studies, 336 participants), 3D endoscopes demonstrated a decreased error rate ( n = 5 studies) and shorter performance time ( n = 3 studies). Studies also reported improved depth perception ( n = 14 studies) and visualisation preference ( n = 5 studies) with 3D over 2D systems. The 3D systems were found to have a shorter learning curve and better manoeuvrability among novice surgeons.
Conclusion
3D endoscopy showed equivalent safety and efficacy compared to 2D endoscopy in otolaryngology surgery. The improved depth perception and performance for novices using 3D endoscopes suggests the technology may be superior to 2D endoscopes as a training tool for otolaryngology surgeons.
Objectives:
This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized.
Design:
Cross-sectional study.
Setting:
Tertiary referral hospital.
Methods:
A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports.
Results:
Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A.
Conclusion:
Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES.
KEY POINTS 1. This is the first study to use a qualitative methodology to assess the potential advantages and disadvantages of the application of 3D endoscopes in pediatric otolaryngology surgery. 2. Open-ended, structured interviews were conducted with six pediatric Otolaryngologist operating at a tertiary pediatric centre, with a minimum one year of experience using a 3D endoscopy system. 3. Thematic analysis of the surgeon’s responses identified 3D endoscopy to provide improved surgical field visualization which thus served as a valuable teaching tool. 4. The surgeons interviewed found 3D endoscopy to improve surgical outcomes in pediatric airway surgery, particularly in surgeries involving the larynx. 5. Further quantitative evaluation of patient outcomes could delineate the precise clinical role 3D endoscopy may hold in future pediatric Otolaryngology practice.
