Can the exoscope be a game-changer for cleft palate surgery?

Abstract

Cleft palate surgery represents a challenge for cleft surgeons, due to functional implications of an adequate reconstruction of the palate in a narrow operative field [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . Surgical loupes remain the mostly used magnification system for soft palate repair all over the world, with some drawbacks: restricted magnification capacity, offering a poor ergonomic posture, and limited surgical staff involvement. Furthermore, it is estimated that about 83% of cleft surgeons suffer from work-related musculoskeletal disorders and palate surgery can be considered one of the most uncomfortable procedures [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . The introduction of the microscope [2] Sommerlad B.C. The use of the operating microscope for cleft palate repair and pharyngoplasty. Plast Reconstr Surg. 2003 Nov; 112: 1540-1541https://doi.org/10.1097/01.PRS.0000085598.26409 Crossref PubMed Scopus (0) Google Scholar for the video-assistance of cleft palate surgery offered stereoscopic vision with higher magnification capabilities, a better ergonomic position and, by connecting a monitor, a better involvement of the surgical staff. However, its use in pediatric transoral surgery presents some difficulties in terms of adaption and challenging setting: for these reasons, the microscope is widely used only for dissection of the muscular plane, limiting its advantages and increasing the surgical times with its setting and dismissal.