3D video-assisted trans-oral removal of deep hilo-parenchymal sub-mandibular stones

Safety and efficacy of three-dimensional versus two-dimensional endoscopy in otolaryngology surgery and training: A systematic review

OBJECTIVE

Three-dimensional (3D) endoscopy has been developed to provide depth perception to allow for improved visualisation during otolaryngology surgery. We conducted a systematic review to determine the surgical safety and efficacy of 3D endoscopy in comparison to two-dimensional (2D) endoscopy in performing otolaryngology procedures, and the role of 3D endoscopy as a training tool for novice otolaryngology surgeons.

METHODS

Primary studies were identified through MEDLINE, Embase and Web of Science databases, which were searched for articles published through June 2022 that compared the outcomes of 2D and 3D endoscopy in otolaryngology surgical procedures or otolaryngology-relevant simulations. Candidate articles were independently reviewed by two authors.

RESULTS

A total of 18 full-text articles met inclusion criteria for this study. In clinical trials (n = 8 studies, 362 subjects), there were no significant differences in performance time, intraoperative or postoperative complications with 3D endoscopes when compared to 2D. In simulation studies (n = 10 studies, 336 participants), 3D endoscopes demonstrated a decreased error rate (n = 5 studies) and shorter performance time (n = 3 studies). Studies also reported improved depth perception (n = 14 studies) and visualisation preference (n = 5 studies) with 3D over 2D systems. The 3D systems were found to have a shorter learning curve and better manoeuvrability among novice surgeons.

CONCLUSION

3D endoscopy showed equivalent safety and efficacy compared to 2D endoscopy in otolaryngology surgery. The improved depth perception and performance for novices using 3D endoscopes suggests the technology may be superior to 2D endoscopes as a training tool for otolaryngology surgeons.

Transoral submandibulotomy plus duct marsupialization; an appropriate approach for the treatment of proximal submandibular sialolithiasis; a long-term follow-up study

BACKGROUND

Sialolithiasis is the most common salivary gland-related disease worldwide, leading to sialadenitis. Although there is no serious problem with surgical removal of stones at the middle and distal parts of the Wharton's duct, the approach for treating proximal stones located near to hilum and its adjacent parenchyma is a challenge. The current study has aimed to evaluate the outcome of transoral submandibulotomy for submandibular gland stone treatment.

METHODS

This study was conducted on 63 patients with proximal (or deep hilar) submandibular sialolithiasis treated with transoral submandibulotomy and duct marsupialization from January 2011 to April 2019 in Pars hospital. Complications of the old fashion surgery (transcervical submandibulectomy) were assessed in this method (number and size of the stone(s), relapse of sialolithiasis-related obstructive symptoms, partial or complete removal of the stone(s), sialolithiasis recurrence, postoperative surgical or nonsurgical intervention, foreign body sensation, and taste sensation quality).

RESULTS

The stone(s) was located at the proximal of the duct in 68% of the cases, while 32% of the stones were located at the deep hilar region. The mean size of the stones was 1.28±0.51 cm. Postoperative inflammation, postoperative pain, sialolithiasis recurrence, obstructive symptoms, postoperative nonsurgical intervention, postoperative surgical intervention, reduced taste sensation, and foreign body sensation were presented in 24%, 29%, 29%, 44%, 14%, 6%, 11%, and 10% respectively. Eighty-nine percent of recurrences were healed spontaneously.

CONCLUSION

Considering the cosmetic advantage due to the lack of cervical surgery scar (which is mandatory in old fashion transcervical method), long-term follow-up of transoral submandibulotomy showed successful outcomes regarding neurological impairment, postoperative pain and inflammation and incredibly complete stone removal that was found in all of the patients. In addition, submandibular duct marsupialization is recommended based on our study.

High Definition Three-Dimensional Exoscope (VITOM 3D) in E.N.T. Surgery: A Systematic Review of Current Experience

Over the last decade, technological growth has developed new devices for more precise surgery based on improved maneuverability, minimally invasive approaches, and magnification of the operating field. In this context, the exoscope has opened a new phase for more accurate and safer microsurgery, improving the perception of the volume of objects and the depth of structures for planning, targeting, and controlling fine movements. The exoscope could be used for middle ear, transcanal, transmastoid, and craniotomy procedures that require two-handed dissection, both to perform both totally VITOM-based techniques and coupled to traditional procedures with an operating microscope or endoscope. In addition, the VITOM 3D system allows the surgeon to work with high-definition images, which is essential in facial nerve surgery or submandibular salivary stone or tear surgery approaches, where magnification plays a fundamental role in surgical success and in reducing operating times. The 3D exoscope approach could also be included in traditional transoral procedures for oropharyngeal carcinoma. The exoscope may provide a relevant approach in teaching surgeons and nurses, allowing adequate training in non-oncological surgical procedures such as a tonsillectomy or lateral pharyngoplasty.

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

Objective

The recent introduction of 3D exoscopic surgery has allowed interesting technical improvements in head and neck surgery resulting in technical solutions that are also applicable to neck dissection. The aim is to replace robotic surgery while minimising the costs of the procedure.

Methods

Based on these considerations, we conducted a preclinical investigation in the cadaver lab focused on approaching conventional neck dissection using a retroauricular incision, and evalute the applications and usefulness of the Storz 3D Exoscopic System at different stages of the surgical procedure. The acronym RAND-3D (3D exoscopic surgery) was coined to describe the application of this optical tool in neck dissection.

Results

The current study in the cadaver lab indicates that RAND-3D is an acceptable alternative operating technique in performing neck dissection by a retroauricular approach. Technically feasible and safe, this technique assures a complete compartment-oriented dissection without damaging major vascular or nervous structures.

Conclusions

This approach can be used in selected cases with a clear cosmetic benefit and represents a valid alternative to endoscopic- and robotic-assisted neck dissection.