Exoscope-assisted middle ear surgery

Abstract The aim of this chapter is to illustrate the application of the 3D exoscope in selected ear surgical procedures and to show the potential advantages of this new technology in the ear surgery field. Despite the exoscope cannot replace the operating microscope at this time, it can be safely used in different ear surgeries. In this chapter, we summarize which procedures are actually indicated or contraindicated to be performed with this new tool, based on our experience. The exoscope is more useful in the case of wide surgical fields, which allow to appreciate its lightness, maneuverability, and compactness, reducing the need for endoscopy and providing the advantage of a great teaching potential. Postauricular approaches are the best suitable for exoscopic surgery. As a consequence, the exoscope can be used in the treatment of middle ear chronic diseases, benign and malignant tumor of the external and middle ear, and in cochlear implantation. Moreover, the use of the same video column provides an easy interchangeability between endoscope and exoscope during the procedure. Exoscopic technology is constantly being improved with the recent development of a robotic holding arm and the continuous tendency to improve the image quality. On the other hand, the exoscope has several limits in the case of endoauricular surgeries, due to the lower image quality at high magnification of bright minute structures. As a consequence, the exoscope does not find a definitive role in these procedures at this time. In conclusion, the exoscope's advantages are not enough to substitute the operating microscope, but it can be considered an additional, innovative tool to implement the ear surgical equipment.