Abstract
BackgroundHigh-definition, three-dimensional (3D) exoscopes are being used to perform a growing number of head and neck surgeries. However, the use of the 3D exoscope in parotid gland surgery has not been previously described. Our initial experience with the VITOM 3D exoscope in the surgical treatment of parotid gland tumors is detailed here.MethodsWe made a prospective study of patients with benign parotid gland tumors indicated for surgical resection. Between January and December 2018, patients were randomly assigned to undergo surgery assisted with the VITOM 3D system (n = 31) or an operating microscope (n = 40). Visualization quality (greater auricular nerve, digastric muscle, tragal pointer), operating time, conversion rates, and surgical outcomes were compared.ResultsA total of 71 patients underwent superficial (n = 18) or total parotidectomy (n = 53). No exoscope-related complications were observed. Five patients undergoing exoscope-guided deep lobe surgery required intraoperative conversion to a microscope. No differences were observed in the subjective quality of intraoperative visualization of key anatomical structures. However, a significantly higher percentage of patients in the exoscope group developed transient facial nerve paralysis (n = 9; 29% vs. n = 4, 10%).ConclusionsThese findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. However, the high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation.
Highlights
In the last decade, the development of three-dimensional (3D) surgical visualization systems—the 3D exoscope—has given surgeons a viable—and potentially superior—alternative to conventional operating microscopes and endoscopes
Patients diagnosed with a benign parotid tumor were qualified for parotidectomy and randomly allocated: every first patient was operated with conventional operative microscope, while every second underwent parotid gland surgery with the high-definition VITOM 3D exoscope
Our findings show that there were no significant differences between the two techniques for most of the variables analyzed, including the duration of surgery and the subjective measures of intraoperative quality concerning the visualization of key anatomic structures (Tables 2 and 3) The only significant difference between the two techniques was the rate of transient facial nerve palsy, which affected 10% (n = 4) of patients in the operating microscope group versus 29% (n = 9) in the exoscope group
Summary
The development of three-dimensional (3D) surgical visualization systems—the 3D exoscope—has given surgeons a viable—and potentially superior—alternative to conventional operating microscopes and endoscopes. Operating microscopes provide comparable illumination and magnification, visualization of the surgical field is limited to the surgeon and assistant, The VITOM 3D exoscope (Karl Storz, Tuttlingen, Germany) is a high-definition exoscope, reported to have been first used in head and neck surgery for free flap head and neck reconstructions. Studies have shown that this device provides sufficient access, reach, and visualization to successfully perform free flap harvesting and microvascular anastomosis [8], making it a superior option to conventional operating microscopes [9]. Conclusions These findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. The high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation
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