Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy,
Department of Biomedical Sciences, Humanitas University, Milan, Italy,
ORL J Otorhinolaryngol Relat Spec. 2021;83(5):381-386. doi: 10.1159/000513529. Epub 2021 Mar 18.
The aim of the study was to investigate the role of the exoscope as an assisting tool in endoscopic dacryocystorhinostomy (e-DCR).
In this observational retrospective study, the application of the VITOM® exoscope was studied in a group of 21 patients undergoing mono- or bilateral DCR. The primary endpoint was to evaluate resolution of symptoms (epiphora/dacryocystitis) at the 6-month follow-up and time for surgery. Qualitative features of the exoscope (intraoperative view of the surgical field) and comparison with the typical setting for DCR were analyzed as secondary endpoints. A questionnaire was administered to surgical team members (ENT surgeon, ophthalmologist, and scrub nurse) to evaluate the perceived quality of this new technology (12 items valued as "good" = 2, "acceptable" = 1, and "not acceptable" = 0). A questionnaire score of 24 out of 24 was valued as "completely approved," score 20-23 as "moderately approved," and score ≤19 as "weakly approved." Patients were divided into 3 consecutive groups, and questionnaire scores by each team member were analyzed for tendencies. Statistical analysis was performed to test significance at p < 0.05. Local Ethical Committee approval was obtained.
No significant differences were found between exoscope-set DCR and classic setting for concerned patient outcomes (failure rate: 3.2 vs. 3.8%, respectively, p = 0.896) and mean time for surgery (20' vs. 23', respectively, p = 0.091). The exoscope was valued by surgical team members as "completely approved" in 55.5% of cases, "moderately approved" in 39.7%, and "weakly approved" in 4.8%. Questionnaire scores by the ENT, ophthalmologist, and scrub nurse showed an average increase in the 3 consecutive groups (p = 0.119, p = 0.024, and p < 0.001, respectively).
The exoscope is a new tool that may support e-DCR. It has no effects on symptom outcomes (epiphora/dacryocystitis) and time for surgery compared to classic DCR. Based on self-perception, this new technology was accepted by all team members.
本研究旨在探讨内窥镜下鼻腔泪囊吻合术（e-DCR）中使用手术显微镜作为辅助工具的作用。
在这项观察性回顾性研究中，研究了 21 例接受单或双侧 DCR 患者中使用 VITOM®手术显微镜的情况。主要终点是评估 6 个月随访时症状（溢泪/泪囊炎）的缓解情况和手术时间。将手术显微镜的定性特征（手术野的术中视图）及其与典型 DCR 设置的比较作为次要终点进行分析。向手术团队成员（耳鼻喉科医生、眼科医生和洗手护士）发放调查问卷，评估这项新技术的感知质量（12 项按“好”=2、“可接受”=1 和“不可接受”=0 评分）。24 分满分中获得 24 分被视为“完全认可”，20-23 分视为“中度认可”，≤19 分视为“轻度认可”。患者分为 3 个连续组，分析每位团队成员的问卷评分趋势。采用统计学分析检验 p < 0.05 的显著性。获得了当地伦理委员会的批准。
在患者结局（失败率：分别为 3.2%和 3.8%，p = 0.896）和手术时间（分别为 20'和 23'，p = 0.091）方面，手术显微镜组和经典组之间无显著差异。手术团队成员将手术显微镜评为“完全认可”的占 55.5%，“中度认可”的占 39.7%，“轻度认可”的占 4.8%。耳鼻喉科医生、眼科医生和洗手护士的问卷评分在 3 个连续组中呈平均增加趋势（p = 0.119、p = 0.024 和 p < 0.001）。
手术显微镜是一种新工具，可支持 e-DCR。与经典 DCR 相比，它对症状（溢泪/泪囊炎）和手术时间无影响。根据自我感知，所有团队成员都接受了这项新技术。
