New 3-D Technologies in Salivary Gland Surgery: The Exoscope-Assisted Surgery for Treatment of Benign Tumors of Parotid Gland

Abstract

New technologies are increasingly widespread in medical practice. Particularly, the 3D view is considered among the most useful innovations for surgery. It allows the operator to reconstruct the patient's anatomy in his own mind, going beyond his personal imagination. In the last few years, a new facility has been experienced, it's the Exoscopy. Exoscopy is a magnified vision system, similar to Microscopy, but which also allows a tridimensional vision of the surgical anatomy. Despite Exoscopy having been used for years in Neurosurgery, it has been just rarely described in parotid surgery. We intend to report our experience with Exoscope Aesculap AEOS used to remove benign tumors of the parotid gland. We treated 14 patients with benign tumors of the parotid gland, since September 2023 to November 2023. Each surgery was conducted by the same expert surgeon which also reported his experience about intra-operative complications (as bleeding) in comparison to the traditional procedure without Exoscope. We evaluated the learning curve of Exoscope-Assisted Parotid Surgery comparing, among them, the operative times of the same procedures performed in chronological order. Each patient underwent the same follow-up which included three checks at one month, three months and six months. The follow-up was especially about the evaluation of palsy of the VII C.N. which was assessed through House-Brackmann score (H-B score). The results of our experience reports that the Exoscope is a useful tool for parotid gland surgery. It allows an excellent visualization of the facial nerve main trunk and its branches. Although the first procedures presented longer times in comparison to traditional surgery, the progressive reduction of the operative times demonstrates that the learning curve of Exoscopy is very fast. Certainly, more experience is required for the full introduction of Exoscopy in surgery practice of parotid gland but, now, its potentialities are highly exciting.

Keywords: 3-D technologies; Exoscope; Microscope; Parotid gland; Parotid tumors; Salivary glands; Surgical technique.

Fig. 1

Operative times of surgical procedures corresponding to a good learning curve

Fig. 2

a Idrodissection; b Blair’s incision; c skin flap; d SMAS incision; e blunt dissection of the SMAS; f SMAS dissected and parotid gland exposed; g Tragal Pointer palpation; h FN main trunk found

Fig. 3

a–b Enucleation of the benign tumor, c–d cervicofacial branch of FN; e Retromandibular vein well evident; f drenage pipe positioning into the subSMAS plane; g hermetic closure of the SMAS flap; h skin suture