Ergonomics of 3D Exoscope for Lateral Temporal Bone Resection

Objectives Lateral temporal bone resections (LTBR) with a high-speed drill are regularly performed using an operating microscope for improved magnification, particularly when encountering critical structures such as the facial nerve and lateral semicircular canal. Technology continues to advance with 3D magnification scopes becoming more and more available along with increased options of ergonomic devices that allow suitable magnification for the surgeon and surgical staff. Our objective was to perform a series of LTBRs with use of a 3D exoscope instead of a standard operating microscope, and evaluate the efficacy of the technology for use in LTBRs including improved ergonomics and/or equivalent surgical outcomes compared with a surgical microscope.

Methods A Karl Storz VITOM 3D exoscope was used for a series of five consecutive cases that required a LTBR due to cancer. During the operation, the ergonomics of the device were evaluated which included visualization of the surgical field by the surgeon and surgical staff, ease of use of the device, and surgical outcomes including margin-free status.

Results All five surgical cases using the VITOM 3D exoscope were performed safely and without any complications. The exoscope was able to provide direct line of site for the surgeon and surgical staff, while allowing improved view of the surgical field compared with the operating microscope. The ergonomics of the exoscope allowed improved surgeon comfort and resident education. All cases had margin-free status after LTBR performed.

Conclusion To our knowledge, this is the first description in literature of the use of a 3D exoscope to perform skull base surgery and particularly a LTBR. The 3D exoscope enables the surgeon surgical staff to work more ergonomically when performing a LTBR compared with the operative microscope. In all cases in which the exoscope device was used, margin free status was obtained and has equivalent surgical outcomes compared with the surgical microscope.

No conflict of interest has been declared by the author(s).