Abstract
Objectives: The widespread application of endoscopic ear surgery (EES), performed through the external auditory canal, has revealed the limitations of the one-handed technique. The RobOtol® (Collin ORL, Bagneux, France) otological robotic system has been introduced to enable two-handed procedures; however, the thermal properties of dedicated endoscopes, which are usually used in neurosurgery, called “neuro-endoscopes,” have not yet been clarified for the robotic systems. In this study, we aimed to profile the thermal characteristics of two dedicated neuro-endoscopes, as compared to endoscopes used routinely in manual EES, called “oto-endoscopes,” and defined by a smaller diameter and shorter length, and to discuss the safe application of robotic assistance in EES.Methods: Two neuro-endoscopes (3.3 mm, 25 cm, 0°/30°) were studied using two routine light sources (LED/xenon), and two routine oto-endoscopes (3 mm, 14 cm, 0°/30°) were initially measured to provide a comprehensive comparison. Light intensities and temperatures were measured at different power settings. The thermal distributions were measured in an open environment and a human temporal bone model of EES. The cooling measures were also studied.Results: Light intensity was correlated with stabilized tip temperatures (P < 0.01, R2 = 0.8719). Under 100% xenon power, the stabilized temperatures at the tips of 0°, 30° neuro-endoscopes, and 0°, 30° oto-endoscopes were 96.1, 60.1, 67.8, and 56.4°C, respectively. With 100% LED power, the temperatures decreased by about 10°C, respectively. For the 0° neuro-endoscope, the illuminated area far away 1cm from the tip was below 37°C when using more than 50% both power, while this distance for 30° neuro-endoscope was 0.5 cm. In the EES temporal bone model, the round window area could reach 59.3°C with the 0° neuro-endoscope under 100% xenon power. Suction resulted in a ~1–2°C temperature drop, while a 10 mL saline rinse gave a baseline temperature which lasted for 2.5 min.Conclusion: Neuro-endoscope causes higher thermal releasing in the surgical cavity of ESS, which should be especially cautious in the robotic system usage. Applying submaximal light intensity, a LED source and intermittent rinsing should be considered for the safer robot-assisted EES using a neuro-endoscope that allows a two-handed surgical procedure.
Highlights
Endoscopic ear surgery (EES) has become a popular technique in recent years as a result of its better exposure and closer view of micro-anatomic structures in the middle ear [1, 2]
Four regular Karl Storz endoscopes were investigated: the Hopkins 28007AA (3.3 mm diameter, 0◦ tip, 25 cm length) and Hopkins 28007BA (3.3 mm, 30◦, 25 cm), which are conventionally used in neurosurgery, and are used with a robotic system dedicated for ear surgery (RobOtol R, Collin ORL, Bagneux, France), and the Hopkins 7220AA (3 mm, 0◦, 14 cm) and Hopkins 7220BA (3 mm, 30◦, 14 cm), which are conventionally used in otology
Light intensity increased with power setting (Figures 2A–C) and differed among the four endoscopes
Summary
Endoscopic ear surgery (EES) has become a popular technique in recent years as a result of its better exposure and closer view of micro-anatomic structures in the middle ear [1, 2]. Endoscope holders for endoscopic surgery [5,6,7,8] and robotic arms such as RobOtol R (Collin ORL, Bagneux, France) [9] have been introduced to enable two-handed procedures. To adapt these devices, longer endoscopes [10, 11] had to be applied in order to avoid the interference between surgeon’s hands and robotic arm/ endoscopic holder. The usage of endoscopic holder or robotic system changes the surgical mode for endoscope, that the endoscope stays longer and more statically in EAC. These factors might potentially bring out thermal damage to local tissue
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