New Frontiers in Pediatric Cochlear Implant Surgery - A Single Center Experience with the 3-Dimensional Exoscope.

Since its introduction by Wullstein, the binocular surgical microscope has remained the gold standard of visualization in the field of otology. However, in the last decade, new technology became available in the form of the three-dimensional (3D) exoscope. In this article, we describe our experience thus far in pediatric cochlear implantation with the 3D exoscope. This article is about prospective descriptive study of all exoscopic cochlear implant (CI) cases in a quaternary pediatric CI center performed with the Vitom® 3D system. All pediatric patients (age <18) were included without exclusion criteria, and our experience and conversion to microscope rates are reported. Since the introduction of the exoscope to our unit, we have successfully performed 68 cases, of which 53 were bilateral cochlear implantations. The age of the patient varied between 10 months and 209 months (average: 64 months; median 46.5 months). There were a total of 121 implantations (96 primary implantations, 24 revision implantations). There were 2 conversions to the traditional microscopic technique. The exoscope provides a 3D high-definition (4K) images in CI surgery. There is limited data regarding its use, and we identified a number of advantages including efficiency, occupational health, theater utilization, surgical training, and safety. Although there are areas still for improvement, such as loss of signal-to-noise ratio at higher magnification, manual focus, and lack of electromagnetic articulation in the holding arm, we have found it to be a useful addition to the surgical armamentarium within pediatric cochlear implantation.