Three-dimensional exoscope-assisted laser stapedotomy: a preliminary experience

Abstract

Purpose: Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known advantages in otological surgery. This study aims to evaluate exoscopes role in stapes surgery, both from a surgical perspective and on the educational profile.

Methods: Seven consecutive otosclerosis patients underwent single-sided endaural laser stapedotomy with a 4K 3-dimensional exoscope. The surgical setting allowed all operating room personnel 3-dimensional vision. Pre- and postoperative pure tone audiometry and air-bone gaps, and information on the postoperative course and complications were systematically collected. An informal ergonomic evaluation was carried out by the operating room personnel and an informal didactic evaluation was provided by the trainees. A comparable group of microscope-assisted stapedotomy patients undergoing the same procedures and evaluations was chosen as a control group.

Results: Outcomes were solid in all patients, median air-bone gap decreased from 26.5 to 10 dB at the 3-month evaluation (p = 0.01, Wilcoxon's test). No vertigo, tinnitus, or facial palsy was reported. The median operating time was 40 min. The compact design and configuration of the exoscope allowed more practical management of the operating theater. All personnel had the chance for a better understanding of the procedure and trainees felt more confident when asked to identify surgical landmarks and procedure steps. Audiological outcomes, operative times, and complication rates were not different between study and control groups.

Conclusion: Though further validation and systematic comparison with microscope- and endoscope-assisted stapedotomy are required, the exoscope proved a safe, practical, and educational tool.

Keywords: Exoscope; Otosclerosis; Stapedotomy; Three-dimensional vision; Video-assisted surgery.

Fig. 1

The image shows the operating theatre setting, with the scrub nurse positioned at the head of the patient and the surgeon in the head-up position while operating the right side ear

Fig. 2

The image shows different steps of the surgical procedure viewed through the exoscope. Upper left: curettage of the posterosuperior bony ear canal. Lower left: oval window exposure with the titanium piston visible in the surgical field. Upper right: one-shot diode laser stapedotomy. Lower right: titanium piston crimped to the long process of the incus