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Otology/Neurotology

(189) Exoscope-Assisted Transcanal and Endaural Middle Ear Surgery

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Marc Polanik, MD

    Otolaryngology Resident
    Penn State Hershey Medical Center
    Hummelstown, Pennsylvania, United States

    • Co-Author(s)

  • JL

    Jeffrey Liaw, MD

    Otolaryngologist
    University of Missouri
    Columbia, Missouri, United States

  • RS

    Robert A. Saadi, MD

    Resident Physician
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

    • Senior Author(s)

  • Huseyin Isildak, MD

    Professor of Surgery
    Stony Brook Medicine
    Stony Brook, , New York, United States

Disclosure(s):
Marc Polanik, MD: No relevant relationships to disclose.
Jeffrey Liaw, MD: No relevant relationships to disclose.
Robert A. Saadi, MD: No relevant relationships to disclose.
Huseyin Isildak, MD: No relevant relationships to disclose.


Introduction: The viability of 3-dimensional, high definition (3D-HD) exoscopes is well documented in lateral skull base surgery but not in otologic surgery. In this feasibility study, we describe our initial experience using a 3D-HD exoscope for transcanal and endaural middle ear surgery.

Methods: Study

Design: Retrospective case series

Setting: Tertiary academic center

Patients: Patients undergoing exoscope-assisted otologic surgery using a transcanal or endaural approach

Interventions: A retrospective case series was performed examining patients undergoing exoscope-assisted otologic surgery using a transcanal or endaural approach.

Main Outcome Measures: Surgical approach, operative time, feasibility, complications, surgeon comfort, and procedure type were reviewed.

Results: Two procedures were included; an endaural revision radical tympanomastoidectomy with eustachian tube plugging and a transcanal stapedectomy. The operative time was 154 minutes for the tympanomastoidectomy and 91 minutes for the stapedectomy. No intraoperative complications were encountered and at no point was a binocular operative microscope necessary. The surgeons commented on the high quality of the 3D-HD display, improved visualization secondary to increased degrees of freedom of exoscope adjustment, superior ergonomics, and reduced surgeon fatigue. Noted shortfalls included the smaller focal window compared to the microscope, increased eyestrain with prolonged use of the monitor, and occasional need to alter hand positioning to accommodate the exoscope camera at certain angles.

Conclusions: The exoscope is a safe and viable alternative to the operative microscope for transcanal and endaural otologic procedures. It can provide excellent visualization in these narrow operative corridors without compromising patient safety or surgical exposure.