Endoscopic Cartilage Boomerang Ossiculoplasty- as Total Ossicular Replacement Using Endoscope Holder

Modified Circular Knife in Two-Handed Endoscopic Ear Surgery: A Technical Note

With the introduction of endoscope to middle ear surgery, certain modifications are required in the middle ear instruments to reach the nook and corners of the middle ear without compromising vision and leading to cross-over of instruments. In this manuscript we describe and discuss the modified circular knife and enumerate its advantages and applications during two handed endoscopic ear surgery.

Feasibility and Applicability of Portable Goose Neck System as a Third Arm for Holding Endoscope in Two Handed Endoscopic ENT Surgeries

Endoscopes have revolutionised and have added a new dimension to the surgical domain. Many surgical techniques have reformed from the open surgical approach to a minimal access endoscopic one. In otolaryngology too, the indications and the use of endoscopes have been increasing in the last few decades. Even in otology, slowly and steadily Wulstein's microscopic techniques have been changing to endoscopic techniques. The only disadvantage of endoscopic ear surgery is that it is a single handed technique as the non dominant hand is utilised in holding the endoscope. We have developed portable endoscope holder based on the Goose neck system with rack and pinion mechanism. The goose neck system acts as a third arm to hold the endoscope. The novel portable endoscope holder bears the potential to provide benefits for various endoscopic ear nose and throat surgeries. We present our experience of feasibility and applicability of this endoscope holder.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03604-9.

A Perfect Bent Flag Knife- Significance and Relevance During Two Handed Endoscopic Ear Surgery

The micro-ear instruments are designed to work with the operating oto-microscope where the principle of working depends on the magnification and the focal length of the objective lens. During the endoscopic ear surgery, the length of instrument interferes with the length of the endoscope making the working under the lens difficult. Hence certain modifications are required in the existing micro ear instruments so as to be used in endoscopic ear surgery to reach the nooks and corners of the middle ear. In this manuscript, we describe the angle rendered to the flag knife.

Portable Gas Spring with Rachet and Pinion System as a Third Arm for Holding Endoscope in Two Handed Endoscopic ENT Surgery

The role of endoscope has been changing from that being an adjuvant during microear surgery to the exclusive endoscopic middle ear surgery. However the only disadvantage of endoscopic ear surgery is its single handed technique as the non-dominant hand is used to hold the endoscope. We propose the concept and design of our portable endoscope holder for two handed endoscopic ear surgery. It is based on the gas spring action and rack and pinion system which act as a third arm to hold the endoscope. The novel portable endoscope holder bears the potential to provide benefits for various two handed endoscopic ear nose and throat surgeries. Level of evidence: Level V.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03246-3.

Does the angle of the intsruments matter during two handed endoscopic ear surgery?

The micro-ear instruments are designed to work with the operating oto-microscope where the principle of working depends on the magnification and the focal length of the objective lens. The focal length of the microscope allows a greater working distance for manipulation of the instruments. During the endoscopic ear surgery, the length of instrument interferes with the length of the endoscope making the working under the lens difficult. Hence reaching to the corners of the middle ear becomes impossible with the straight micro-ear instruments during endoscopic ear surgery. Hence certain modifications are required in the existing micro ear instruments so as to be used in endoscopic ear surgery.