The HD-Panoramic Visualization System: a new visualization system for ENT surgery

Abstract

This work examines the application possibilities of a new visualization system, the Panoramic Visualization System (HD-PVS), in ENT surgery. The Panoramic Visualization System (PVS) is a novel optical system that is neither an endoscope nor a microscope. It has a focal length of 200 mm, a wide field of view and is used together with an HD camera and an HD monitor (HD-PVS). The analysis of the visualization quality took place in laboratory conditions using 4 close-to-surgery scenarios with altogether 40 data points. Further, the system was used on patients in 45 procedures (tympanoplasty, parotidectomy, neck dissection, septumplasty, transfacial approaches). The results were analyzed following the ICCAS workflow-scheme and with standardized questionnaires. In the analysis of the visualization quality, the PVS exhibited the best total evaluation in the lab test in two out of four scenarios. In one of four scenarios, the PVS as well as the microscope achieved the maximum attainable score. In one out of four scenarios, the endoscope attained a better result than the PVS. The microscope was never superior to the HD-PVS in terms of image quality. In four out of five clinical applications, the PVS was evaluated as operational with slight modifications. Most development is needed in middle ear surgery applications. The remaining procedures already benefit in the system configuration examined here, and they were regularly accomplished with support of the PVS. The present study offers a good basis for introducing the PVS to ENT surgery. The advantages over the existing gold standard include lower initial costs for the optical system than for an operating microscope since the HD-video system is often already in place, smaller space requirements than a microscope, equal or at times better visualization quality than the microscope, the possibility of videoendoscopic representation of surgeries in which this was impossible before, and better ergonomic conditions.

Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM®)

“…15 Several other surgeons have used the VITOM Ò for spinal surgery, vascular and cardiac surgery, ENT surgery, hepatic surgery, and experimental small animal surgery. 16 In most of these settings, the VITOM Ò has provided high quality imaging and facilitated surgical resection as an alternate to the operating microscope or loupes. In general, the VITOM Ò has proven extremely useful when the surgical field is largely perpendicular to the line of site of the surgeon because the anatomy can be well-visualized and the surgeon operating from the monitor maintains a head position similar to that with the microscope.…”

The utility of the exoscope compared to the operating microscope in simulated temporal bone surgery

“…In some cases, both the operating microscope and exoscope were used. A further paper by Minoda and Miwa 13 described two cholesteatoma cases undertaken using a combination of endoscope and exoscope. Finally, Rubini et al 9 described a series of 12 patients undergoing a wide range of lateral skull base surgery using the Storz Vitom exoscope and compared the results with 12 patients undergoing similar surgery using a microscope.…”

Initial Experience with 3‐Dimensional Exoscope‐Assisted Transmastoid and Lateral Skull Base Surgery

“…Limited trials of exoscope use in neurosurgery and otolaryngology have indicated benefits with regard to surgical ergonomics, compact size, and image quality. [1][2][3] Indeed, otolaryngologists are at risk for work-related neck and back pain that is thought to be due, in part, to prolonged microscope usage. 4 A monitor-based display that liberates surgeons from needing to conform to line-of-sight binocular eyepieces could eliminate a potential source of detrimental surgical ergonomics.…”