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Randomized Controlled Trial
. 2022 Feb;279(2):1029-1034.
doi: 10.1007/s00405-021-06876-5. Epub 2021 May 28.

Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

Ewelina Bartkowiak  1 , Łukasz Łuczewski  2 , Jadzia Tin-Tsen Chou  2 , Małgorzata Wierzbicka  2
Affiliations
Randomized Controlled Trial

Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

Ewelina Bartkowiak et al. Eur Arch Otorhinolaryngol. 2022 Feb.

Abstract

Background: High-definition, three-dimensional (3D) exoscopes are being used to perform a growing number of head and neck surgeries. However, the use of the 3D exoscope in parotid gland surgery has not been previously described. Our initial experience with the VITOM 3D exoscope in the surgical treatment of parotid gland tumors is detailed here.

Methods: We made a prospective study of patients with benign parotid gland tumors indicated for surgical resection. Between January and December 2018, patients were randomly assigned to undergo surgery assisted with the VITOM 3D system (n = 31) or an operating microscope (n = 40). Visualization quality (greater auricular nerve, digastric muscle, tragal pointer), operating time, conversion rates, and surgical outcomes were compared.

Results: A total of 71 patients underwent superficial (n = 18) or total parotidectomy (n = 53). No exoscope-related complications were observed. Five patients undergoing exoscope-guided deep lobe surgery required intraoperative conversion to a microscope. No differences were observed in the subjective quality of intraoperative visualization of key anatomical structures. However, a significantly higher percentage of patients in the exoscope group developed transient facial nerve paralysis (n = 9; 29% vs. n = 4, 10%).

Conclusions: These findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. However, the high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation.

Keywords: Ergonomics; Exoscope; Microscope; Parotid gland surgery; Parotidectomy.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
High definition 2D reproduction from exoscope of the intraoperative field, visualization of FN in the parotid parenchyma. FN facial nerve, SL superficial lobe, DL deep lobe
Fig. 2
Fig. 2
High definition 2D reproduction from exoscope of the intraoperative field, visualization of FN surrounding the tumor. FN facial nerve, P parenchyma, T tumor
Fig. 3
Fig. 3
Per-operative image from microscope, visualization of FN surrounding the tumor. FN facial nerve, P parenchyma, T tumor
Fig. 4
Fig. 4
The surgical team utilizing the external monitor of the 3D exoscope for high-resolution visualization of the parotid gland
See this image and copyright information in PMC

References

    1. Khalessi AA, Rahme R, Rennert RC, Borgas P, Steinberg JA, White TG, Santiago-Dieppa DR, Boockvar JA, Hatefi D, Pannell JS, Levy M, Langer DJ (2019). First-in-Man Clinical Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery. Oper Neurosurg (Hagerstown, Md.), 16(6), 717–725. 10.1093/ons/opy320 - PubMed
    1. Beez T, Munoz-Bendix C, Beseoglu K, et al. First clinical applications of a high definition three-dimensional exoscope in pediatric neurosurgery. Cureus. 2018;10(1):e2108. doi: 10.7759/cureus.2108. - DOI - PMC - PubMed
    1. Roethe AL, Landgraf P, Schröder T, Misch M, Vajkoczy P, Picht T. Monitor-based exoscopic 3D4k neurosurgical interventions: a two-phase prospective-randomized clinical evaluation of a novel hybrid device. Acta Neurochir. 2020;162(12):2949–2961. doi: 10.1007/s00701-020-04361-2. - DOI - PMC - PubMed
    1. Barbagallo G, Certo F. Three-dimensional, high-definition exoscopic anterior cervical discectomy and fusion: a valid alternative to microscope-assisted surgery. World Neurosurg. 2019;130:e244–e250. doi: 10.1016/j.wneu.2019.06.049. - DOI - PubMed
    1. Oertel JM, Burkhardt BW. Vitom-3D for exoscopic neurosurgery: initial experience in cranial and spinal procedures. World Neurosurg. 2017;105:153–162. doi: 10.1016/j.wneu.2017.05.109. - DOI - PubMed

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