Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Otol Neurotol. 2024 Apr 1;45(4):410-414. doi: 10.1097/MAO.0000000000004138. Epub 2024 Feb 28.
The operating microscope (OM) commonly used in ear surgeries has several disadvantages, including a low depth of field, a narrow field of view, and unfavorable ergonomic characteristics. The exoscope (EX) was developed to overcome these disadvantages. Herein, we compared OM and EX during mastoidectomy and found out the feasibility of the EX.
Prospective randomized comparative study.
Tertiary academic medical center.
Patients who had mastoidectomy for chronic otitis media with or without cholesteatoma between January 2022 and April 2022.
Canal wall-up mastoidectomy (CWUM) or canal wall-down mastoidectomy (CWDM) using OM or EX without endoscope.
Operative setting time (the time between the end of general anesthesia and incision), operative time (from incision to suture), postoperative audiologic outcomes, perioperative complications, and the decision to switch from EX to OM.
Of 24 patients who were diagnosed with chronic otitis media or cholesteatoma, 12 each were randomly assigned to the OM or EX group. The mean operation time was 175 ± 26.5 minutes and 172 ± 34.6 minutes in the EX and OM group, respectively, which was not significantly different ( p = 0.843). The procedures in the EX group were successfully completed using a three-dimensional (3D)-EX without conversion to OM. All surgeries were completed without any complications. The postoperative difference in the air and bone conduction was 11.2 and 12.4 dB in the EX and OM groups, respectively, which was not significantly different ( p = 0.551).
EX is comparable to OM in terms of surgical time, complications, and audiologic outcomes following mastoidectomy. The EX system is a potential alternative to OM. However, further improvements are required to overcome some drawbacks (deterioration of image resolution at high magnification, requirement of an additional controller for refocusing).
耳科手术中常用的手术显微镜（OM）存在景深低、视野窄和不利于人体工程学等缺点。外窥镜（EX）的开发就是为了克服这些缺点。在此，我们比较了 OM 和 EX 在乳突切除术期间的表现，以验证 EX 的可行性。
前瞻性随机对照研究。
三级学术医学中心。
2022 年 1 月至 2022 年 4 月期间因慢性中耳炎伴或不伴胆脂瘤而行乳突切除术的患者。
使用 OM 或 EX（无内镜）进行完壁式乳突切除术（CWUM）或开放式乳突切除术（CWDM）。
手术设置时间（全麻结束至切口的时间）、手术时间（从切口到缝合的时间）、术后听力结果、围手术期并发症以及从 EX 转为 OM 的决定。
24 例被诊断为慢性中耳炎或胆脂瘤的患者中，12 例随机分为 OM 组或 EX 组。EX 组和 OM 组的平均手术时间分别为 175 ± 26.5 分钟和 172 ± 34.6 分钟，差异无统计学意义（p = 0.843）。EX 组的手术在无需转换为 OM 的情况下，使用三维（3D）EX 成功完成。所有手术均无并发症完成。EX 组和 OM 组的气骨导差分别为 11.2 和 12.4 dB，差异无统计学意义（p = 0.551）。
EX 在乳突切除术后的手术时间、并发症和听力结果方面与 OM 相当。EX 系统是 OM 的一种潜在替代方案。然而，仍需要进一步改进以克服一些缺点（高倍放大时图像分辨率下降、需要额外的控制器进行重新聚焦）。
