Department of Otorhinolaryngology Head and Neck Surgery, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy.
Eur Arch Otorhinolaryngol. 2021 Nov;278(11):4217-4223. doi: 10.1007/s00405-020-06510-w. Epub 2021 Jan 2.
The aim of this study was to evaluate the potential of 3D exoscope (EX) in selected ear procedures assessing if this new technology could be an improvement in the field of ear surgery.
A case series of consecutive patients surgically treated with a post-auricular approach using EX was retrospectively compared with a similar previous series treated with operating microscope (OM). Patient demographics, indications for surgery, procedure type, complications, operating room setting time (ORst), operative time, adequacy of visualization, image quality, ergonomics aspects, instrument usability, and technique as a teaching tool were investigated. Thirteen patients were included in each group. Surgical procedures in EX group were nine tympanoplasties with mastoidectomy, 1 mastoidectomy for acute complicated mastoiditis, 1 revision miringoplasty, and 2 cochlear implants. Same types of procedures were enrolled in OM group.
No statistically significant difference was found between the two groups concerning ORst and operative time. In EX group, one complication occurred--a middle cranial fossa cerebrospinal fluid leak. Advantages of EX were lightness, maneuverability and compactness, less need of endoscopy during surgery, and teaching potential. Limits were a need of a large surgical corridor and the bright structures rendering in high magnification.
EX resulted safe and efficient in treating diseases of the middle ear in post-auricular approaches. To date, EX advantages are not enough to abandon the OM, and it can be considered as an additional, innovative tool to be added to ear surgical equipment.
本研究旨在评估 3D 外窥镜（EX）在选择的耳部手术中的应用潜力，评估该新技术是否可以改善耳部手术领域。
回顾性比较了一组连续接受 EX 耳后入路手术的患者病例系列，与之前使用手术显微镜（OM）治疗的类似系列进行比较。研究了患者人口统计学资料、手术指征、手术类型、并发症、手术室设置时间（ORst）、手术时间、可视化程度、图像质量、手术舒适度、器械可用性以及作为教学工具的技术。每组均纳入 13 例患者。EX 组的手术包括 9 例鼓室成形术伴乳突切除术、1 例急性复杂乳突炎乳突切除术、1 例再修复鼓膜成形术和 2 例人工耳蜗植入术。OM 组纳入了相同类型的手术。
两组间 ORst 和手术时间无统计学显著差异。EX 组发生 1 例并发症——中颅窝脑脊液漏。EX 的优点是轻便、灵活、紧凑，术中对内窥镜的需求减少，具有教学潜力。缺点是需要较大的手术通道和高倍放大时明亮结构的渲染。
EX 在经耳后入路治疗中耳疾病方面是安全有效的。到目前为止，EX 的优势还不足以放弃 OM，它可以被认为是耳部手术设备的附加创新工具。
