Is the exoscope ready to replace the operative microscope in transoral surgery?

Abstract

Exoscopes are external digital devices that provide enhanced and magnified visualization of the surgical field. They usually have dedicated digital controls and a more compact mechanical structure than operative microscopes and current robotic surgical systems. This technology has significant potential in otolaryngology - head and neck surgery, especially concerning the field of transoral approaches. We herein analysed the overall technical characteristics of currently available exoscopic systems and contextualized their advantages and drawbacks in the setting of transoral surgery. The actual advantages of exoscopy are still indeterminate, as it has only been applied to limited surgical series. However, its specific properties are herein compared with conventional transoral microsurgery and transoral robotic surgery, discussing the available literature on such a topic, filtered on the basis of the authors' experience and its possible future evolutions. Finally, a summary of current experiences in the field of three-dimensional (3D) transoral exoscopic surgery is presented, highlighting differences compared with standard approaches. 3D-exoscopic transoral surgery will possibly play an essential role in future management of early laryngeal and oropharyngeal lesions, significantly shifting the paradigms of this type of procedures.