Wierzbicka Małgorzata, Szyfter Witold, Greczka Grażyna, Gawęcki Wojciech
Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, 60-355 Poznań, Poland.
J Clin Med. 2021 Feb 16;10(4):777. doi: 10.3390/jcm10040777.
The aim of the study was to describe our initial experience with the high-definition three-dimensional (3D) exoscope for middle ear surgery versus the operating microscope.
The study included 60 randomly chosen patients diagnosed with otosclerosis ( = 30) or chronic otitis media ( = 30) with a clinical indication for surgery. The primary measurement was the subjective estimation of quality of the visibility of the operating field provided by the 3D exoscope-VITOM-3D (Karl Storz, Tuttlingen, Germany) in comparison to the operating microscope.
All procedures, except for two (3.3%) converted to the microscope, were successfully completed using a 3D exoscope. In both stapedotomy and tympanoplasty, the exoscope was superior to the microscope during more superficial portions of the procedures. By contrast, in deeper areas of the middle ear, the exoscope provided significantly worse visibility, but usually not suboptimal. Both intraoperative bleeding and the narrow surgical field substantially reduced the visibility with the 3D exoscope in comparison to the microscope.
Overall, our study shows that the 3D exoscope offers excellent, highly magnified, and well-illuminated high-definition images of the surgical field. However, our experience revealed several important limitations of this system, including decreased depth perception in deep areas of the tympanic cavity and reduced visibility in a difficult surgical field, with subsequent need to switch to an operating microscope in select cases.
本研究的目的是描述我们在中耳手术中使用高清三维（3D）外视镜与手术显微镜的初步经验。
该研究纳入了60例随机选择的患者，他们被诊断为耳硬化症（n = 30）或慢性中耳炎（n = 30），且有手术的临床指征。主要测量指标是与手术显微镜相比，对3D外视镜-VITOM-3D（德国图特林根卡尔·史托斯公司）所提供手术视野可见度质量的主观评估。
除2例（3.3%）转为使用显微镜外，所有手术均使用3D外视镜成功完成。在镫骨切除术和鼓室成形术中，外视镜在手术较浅部分优于显微镜。相比之下，在中耳较深区域，外视镜的可见度明显较差，但通常并非次优。与显微镜相比，术中出血和狭窄的手术视野均显著降低了3D外视镜的可见度。
总体而言，我们的研究表明，3D外视镜可提供手术视野出色、高度放大且照明良好的高清图像。然而，我们的经验揭示了该系统的几个重要局限性，包括鼓室深部区域深度感知下降以及在困难手术视野中可见度降低，因此在某些情况下需要改用手术显微镜。
