Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic

Ally, Munira; Kullar, Peter; Mochloulis, George; Vijendren, Ananth

doi:10.1017/s002221512100044x

Cited by 12 publications

(22 citation statements)

References 9 publications

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“…To overcome the obstacle of personal contamination through patient care, several methods have been studied/suggested (Cottrell et al, 2020;Ally et al, 2021;Chari et al, 2021): personal protective equipment (PPE) for clinics and the ORs, a shift to telehealth communication, environmental protection (microscope draping, tents), modification of surgical settings and alteration of surgical techniques (actively preferring endoscopic approaches, use of exoscopes, use of enhanced smoke/suction devices, povidone-iodine irrigation of mastoid). SARS-CoV-2 testing is pre-operatively advised, and if the test is negative, additional precautions may not be necessary.…”

Section: Changes In Conceptmentioning

confidence: 99%

Otitis Media Practice During the COVID-19 Pandemic

Marom¹,

Pitaro

Shah

et al. 2022

Front. Cell. Infect. Microbiol.

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The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.

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Section: Changes In Conceptmentioning

confidence: 99%

Otitis Media Practice During the COVID-19 Pandemic

Marom¹,

Pitaro

Shah

et al. 2022

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

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“…As a result, 17 per cent of surgeons in this study did not feel that the image quality or the magnification were adequate for performing the fine middle-ear procedures requested of them, such as manipulation of the ossicular chain. Whilst Ally et al 6 did not find this to be a problem during their combined approach tympanoplasty case study, they did experience glare when looking down the ear canal with a speculum associated with the brightness of the Vitom 3D camera system. Our work found that the glare could be minimised in such cases by reducing the brightness to the desired level via the Vitom 3D system's control console.…”

Section: Discussionmentioning

confidence: 96%

“…This study, with a level of evidence of 4, assessed the feasibility of performing otological surgery using the Vitom 3D exoscope, instead of the traditional operating microscope, whilst donned in full PPE. The literature has demonstrated the safe use of 3D exoscope systems in a range of ENT operations, including lateral skull base work and mastoid surgery, through a series of published case reports 6 , 14 , 15 and retrospective case–control series. 8 , 10 , 12 Our qualitative study was designed to complement the existing body of published work on exoscope systems, by assessing the experience of ENT surgeons at different stages of their career.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst Ally et al . 6 did not find this to be a problem during their combined approach tympanoplasty case study, they did experience glare when looking down the ear canal with a speculum associated with the brightness of the Vitom 3D camera system. Our work found that the glare could be minimised in such cases by reducing the brightness to the desired level via the Vitom 3D system's control console.…”

Section: Discussionmentioning

confidence: 99%

“…It is also claimed that the exoscope permits a more ergonomic operating position for the surgeon, and unparalleled visualisation for assistants and observers. 6 …”

Section: Introductionmentioning

confidence: 99%

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Feasibility study of the Vitom 3D exoscope in ENT surgery using an animal model: relevance to coronavirus disease 2019

et al. 2021

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Objective The application of a 4K display resolution three-dimensional exoscope system (Vitom 3D) was evaluated to determine the feasibility of adopting the system in ENT surgery in the coronavirus disease 2019 era and beyond. Methods Eighteen ENT surgeons performed structured otological tasks on fresh-frozen sheep heads using the Vitom 3D. Structured feedback of the participants’ experience was analysed. Results Seventy-four per cent and 94 per cent of participants reported that the Vitom 3D was ergonomic and comfortable to use respectively. Whilst colour fidelity and image quality were very good, 50 per cent of participants reported image distortion and pixilation at the highest magnification. All participants agreed that there was an increased educational value to exoscope technology. Half the participants preferred the microscope over the Vitom 3D for fine otological work, which may reflect the learning curve. Conclusion The Vitom 3D exoscope is a promising and viable alternative for performing otological surgery when using full personal protective equipment in the coronavirus disease 2019 era.

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Validation of the novel Deep Reality Viewer (DRV) 3D digital stereo viewer in otology surgery

Milner

Denton

Moen

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Magnification with accurate optic reproduction of the surgical field is essential in otology surgery, but current technologies are subject to specific disadvantages. This study aims to evaluate a novel 3D digital stereo viewer, the Deep Reality Viewer (DRV), in otology surgery, in comparison to both a 2D monitor and the gold standard of microscopy. Methods In this prospective clinical research study, ENT consultants and trainees evaluated visual and practical applications of the DRV. In visual assessment, participants ( n = 11) viewed pre-recorded in vivo mastoid exploration displayed on a 2D monitor and the DRV screen. In practical assessment, participants ( n = 9) performed otology surgical tasks on a cadaveric human head using both the microscope and DRV. Face, task-specific (TSV) and global content (GCV) outcomes were assessed using 5-point Likert scale questionnaires. Construct validity was assessed separately. Results The DRV achieved the pre-determined validation threshold of 4 for all validation parameters in both visual and practical assessment. The DRV significantly outperformed the 2D monitor in fourteen of 16 parameters. In comparison to microscopy, there was no significant difference in 13 of 16 parameters, with the DRV significantly outperforming in the remaining 3: defining anatomy (GCV), assessing middle ear anatomy (TSV) and overall TSV. Construct validity was not demonstrated for either technology. Conclusion The DRV achieved the validation threshold for all parameters, and outperformed the 2D monitor and microscopy in several parameters. This validates the DRV for performing otological procedures, and suggests that it would be a useful alternative to the gold standard of microscopy in otology surgery. Level of evidence N/A.

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Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic

Cited by 12 publications

References 9 publications

Otitis Media Practice During the COVID-19 Pandemic

Otitis Media Practice During the COVID-19 Pandemic

Feasibility study of the Vitom 3D exoscope in ENT surgery using an animal model: relevance to coronavirus disease 2019

Validation of the novel Deep Reality Viewer (DRV) 3D digital stereo viewer in otology surgery

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