Aspects of Otoendoscopic Surgery – Is Robotic Assistance the Key to Success?

Introduction:

Otoendoscopic surgery was introduced by Mer in 1967. It is considered to be more advantageous than the common microscopic approach. Alongside the introduction of active implants, this technique is one of the latest advancements in modern middle-ear surgery. It involves a reduction of the optical distance to a minimum, which thus enables improved access to hidden targets. The microscopic approach nevertheless remains standard, which is mainly attributable to the preference of bimanual manipulation. To date, this major aspect remains insufficiently addressed by endoscopic surgery on account of the lack of an adequate guidance system.

Methods:

In a preclinical study, we aimed to overcome this disadvantage by using an electromagnetic system for endoscope guidance (Medineering, Munich). The system was tested on human fresh-frozen specimens without pathologies. We investigated applicability, visualization and patient safety, especially in comparison to the rigid guidance solutions offered by the endoscope manufacturers.

Results:

In otoendoscopic surgery, the image plane is projected into the surgical situs. This allows for new diagnostic and therapeutic possibilities. The guidance system presented enables bimanual manipulation and steady visualization, similar to the microscopic technique. We performed transmeatal tympanoscopy, cochleostomy, introduction of a CI electrode, stapes piston, antrotomy, mastoidectomy, tympanoplasty, meatoplasty, as well as visualization/manipulation of the round window, the Eustachian tube and chorda tympani.

Conclusion:

A suitable guidance system combines the advantages of bimanual manipulation and high resolution, wide-angle viewing in otoendoscopic surgery. Further investigations will be conducted to verify these initial findings.

Publication History

Publication Date:
23 April 2019 (online)