Raymond Mallory, Soriano Roberto M, Belcher Ryan, Pradilla Gustavo, Solares C Arturo
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States.
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, United States.
J Neurol Surg B Skull Base. 2021 Mar 15;83(Suppl 2):e201-e207. doi: 10.1055/s-0041-1725037. eCollection 2022 Jun.
The three-dimensional (3D) exoscope has several advantages over the operative microscope (OM) but has not been extensively reported for its use in malignant temporal bone resections (TBR). We sought to demonstrate the feasibility of performing TBR, both lateral (LTBR) and subtotal (STBR), using the 3D exoscope for head and neck cancers. present study is a retrospective chart review from August 2016 until August 2019. The study was conducted at a tertiary care center. Patients were undergoing TBR with the Karl Storz VITOM 3D exoscope. Demographics, tumor and surgical characteristics, patient outcomes were the primary measurements of this study. Fifty-five patients underwent 3D exoscopic TBR from 2016 through 2019 of which 18% ( = 10) underwent STBR. The 3D exoscope was used uninterruptedly in all procedures with no intraoperative complications. Most tumors were primarily T3 (42%, = 23) or T4 (55%, = 30) and of cutaneous (62%, = 34) and parotid (27%, = 15) origin. These TBR were often accompanied by infratemporal fossa resections (87%, = 48), auriculectomies (47%, = 26), mandibulectomies (53%, = 29), and parotidectomies (96%, = 53). On final pathology, 24% ( = 13) had microscopically positive margins. Over the study period, 20% ( = 11) of patients had recurrences with a median recurrence time of 5 months (range: 2-30 months). In the largest case series of LTBR and STBR under exclusive 3D exoscopic visualization to date, we demonstrate the 3D exoscope is a feasible alternative to the operative microscope for LTBR and STBR. While oncologic outcomes remain to be clarified, it carries significant potential for use in complex oncologic procedures.
与手术显微镜（OM）相比，三维（3D）外视镜具有若干优势，但在恶性颞骨切除术（TBR）中的应用尚未得到广泛报道。我们试图证明使用3D外视镜对头颈部癌症进行TBR（包括外侧颞骨切除术（LTBR）和次全颞骨切除术（STBR））的可行性。本研究是一项对2016年8月至2019年8月病历的回顾性研究。该研究在一家三级医疗中心进行。患者接受使用卡尔·史托斯VITOM 3D外视镜的TBR。人口统计学、肿瘤和手术特征、患者预后是本研究的主要测量指标。2016年至2019年期间，55例患者接受了3D外视镜下的TBR，其中18%（n = 10）接受了STBR。在所有手术中均不间断地使用3D外视镜，无术中并发症。大多数肿瘤主要为T3（42%，n = 23）或T4（55%，n = 30），起源于皮肤（62%，n = 34）和腮腺（27%，n = 15）。这些TBR通常伴有颞下窝切除术（87%，n = 48）、耳廓切除术（47%，n = 26）、下颌骨切除术（53%，n = 29）和腮腺切除术（96%，n = 53）。最终病理检查显示，24%（n = 13）的患者切缘镜下阳性。在研究期间，20%（n = 11）的患者出现复发，中位复发时间为5个月（范围：2 - 30个月）。在迄今为止最大的仅在3D外视镜可视化下进行LTBR和STBR的病例系列中，我们证明3D外视镜是LTBR和STBR手术显微镜的一种可行替代方案。虽然肿瘤学结局仍有待阐明，但它在复杂肿瘤手术中的应用具有巨大潜力。
