VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

Crosetti, Erika; Arrigoni, Giulia; Manca, Andrea; Fantini, Marco; Caracciolo, Alessandra; Sardanapoli, Francesco; Succo, Giovanni

doi:10.14639/0392-100x-n0757

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…Our experience also confirms some already described limitations of the system, most specifically insufficient light conveying in small surgical corridors and the loss of signal-to-noise ratio at higher magnification levels [ 8 , 10 , 14 ]. The insufficient resolution to grant impeccable view at higher magnification could represent a major issue should the surgeon requires checking the correct positioning of the prosthesis or a suspected perilymphatic leakage around the piston, two possible scenarios that luckily we weren’t required to face.…”

Section: Discussionsupporting

confidence: 87%

“…Furthermore, while both microscope and exoscope remain outside the surgical field, the latter grants 3D vision to the whole surgical team, immersing them in the operator’s perspective [ 6 , 8 – 11 ]. While surgical steps are the same for microscopy and exoscopy, without the need to reposition the articulated arm, the exoscope independent joystick can be controlled by the assistant for zoom, brightness, and image capture without intervention from the operator [ 8 , 10 ]. It is interesting to note that we modified the operating room setting with regard to what Minoda and Miwa proposed [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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

Milanesi¹,

Pasquariello²,

Saibene

et al. 2021

Eur Arch Otorhinolaryngol

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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.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Milanesi¹,

Pasquariello²,

Saibene

et al. 2021

Eur Arch Otorhinolaryngol

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“…While several studies have described an increased operative time as a limitation of the VITOM@ 3D system, 22 we did not observe any difference in surgical time compared to macrosurgery. We also examined the effect of using the VITOM@ 3D on the length of stay in the operating room but found it similar in both groups.…”

Section: Discussioncontrasting

confidence: 86%

Preliminary Experience with 3‐Dimensional Exoscope‐Assisted Laryngoplasty

Sanuki,

Takemoto,

Sumiya

et al. 2023

The Laryngoscope

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ObjectiveLaryngoplasty requires the manipulation of the vocal folds, which are not visible during the operation. The widespread use of this technique is limited by the need for adequate knowledge of anatomy, the small surgical field, and the high level of skill required for the procedure. An exoscope has been developed to provide a stereoscopic view similar to that of a microscope while using the same compact endoscopic tool. This study aimed to determine whether the three‐dimensional (3D) exoscopic surgical technique could be applied to laryngoplasty and explore its possibility to ultimately replace the current approach.MethodsThis was a retrospective case series analysis, which included 28 patients with hoarseness who underwent surgery with (Exoscope; n = 12) or without (Macrosurgery; n = 16) a 3D exoscope between July 2018 and February 2021. The feasibility of performing all surgical steps with the 3D exoscope was evaluated. The Exoscope and Macrosurgery groups were compared for surgical time, vocal function outcomes, and complications. Questionnaires were completed by medical staff regarding the usefulness of medical education.ResultsNo intraoperative or postoperative complications occurred in either procedure. The operative time was similar in both groups. The vocal function outcomes were also comparable between the groups. Questionnaires revealed that the exoscope was useful in terms of sharing information on surgical procedures and anatomy, as well as functioning as an educational tool.ConclusionWhile this was a preliminary study, our results indicated that the exclusive use of the 3D exoscope was feasible for open approaches.Level of EvidenceLevel IV Laryngoscope, 2023

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“…Based on these considerations, we recently carried out a preclinical investigation in the cadaver lab, focused on approaching conventional neck dissection using a retroauricular skin incision, and evaluating the applications and usefulness of the Storz 3D Exoscopic System during different stages of the surgical procedure. The acronym RAND-3D (3D exoscopic surgery) was coined to describe the use of this optical tool to perform neck dissection 5 .…”

Section: Discussionmentioning

confidence: 99%

“…The recent introduction of 3D exoscopic surgery has allowed interesting improvements in head and neck surgery, with technical solutions also applicable to neck dissection, with the aim of replacing robotic surgery and minimising the costs of the procedure. In an earlier paper, a preclinical study on cadavers, our team described the principles of exoscopic-assisted neck dissection via a retroauricular approach, demonstrating its advantages and limitations 5 . The main goal of this study was to describe the application of 3D exoscopic technology on a wide range of pathologies of the neck, benign and malignant, through a minimallyinvasive retroauricular approach.…”

Section: Introductionmentioning

confidence: 99%