Feasibility study of the Vitom 3D exoscope in ENT surgery using an animal model: relevance to coronavirus disease 2019.

OBJECTIVE: The application of a 4K display resolution three-dimensional exoscope system (Vitom 3D) was evaluated to determine the feasibility of adopting the system in ENT surgery in the coronavirus disease 2019 era and beyond. METHODS: Eighteen ENT surgeons performed structured otological tasks on fresh-frozen sheep heads using the Vitom 3D. Structured feedback of the participants' experience was analysed. RESULTS: Seventy-four per cent and 94 per cent of participants reported that the Vitom 3D was ergonomic and comfortable to use respectively. Whilst colour fidelity and image quality were very good, 50 per cent of participants reported image distortion and pixilation at the highest magnification. All participants agreed that there was an increased educational value to exoscope technology. Half the participants preferred the microscope over the Vitom 3D for fine otological work, which may reflect the learning curve. CONCLUSION: The Vitom 3D exoscope is a promising and viable alternative for performing otological surgery when using full personal protective equipment in the coronavirus disease 2019 era.

Training in endoscopic ear surgery using the papaya petiole.

BACKGROUND: Endoscopic ear surgery is a game changer in the field of otology. Training in endoscopic skills is essential for ENT residents, and is especially important during the coronavirus disease 2019 lockdown period. In such difficult times, ENT residents and surgeons can undergo hands-on training using a papaya petiole, even within their homes. OBJECTIVE: Endoscopic ear surgery training can be carried out using a papaya petiole, enabling the practice of grommet insertion, tympanomeatal flap elevation and foreign body removal from the external auditory canal. This model does not need any laboratory setup. RESULTS AND CONCLUSION: The hollow structure of the papaya petiole model is very similar to that of the external auditory canal, making training in endoscopic ear surgery easy. Use of the model helps a beginner to train in endoscopic handling and microsurgical instrumentation, and improves depth perception. In addition, it does not require high-end facilities to store equipment or undertake the training at any given point in time.

Exoscope-assisted Otologic Surgery During the COVID-19 Pandemic.

OBJECTIVE: The recent COVID-19 pandemic has required careful reconsideration of safe operating room practices. We describe our initial experiences performing otologic surgery with the exoscope during the COVID-19 pandemic. METHOD: The exoscope was used for several semiurgent otologic surgeries in combination with complete eye protection, a "tent" drape, a smoke evacuator with ultra-low particulate air filter, and betadine irrigation. These techniques are demonstrated in the accompanying video. This was compared with our experiences using the microscope. RESULTS: The described modified goggles allowed complete eye protection while providing a fully three-dimensional view of the surgical site. The other safety measures described are simple and efficient techniques which can easily be adopted for otologic surgery using the microscope. CONCLUSION: Use of the exoscope for otologic surgery during the COVID-19 pandemic allows full three-dimensional visualization of the surgical field while simultaneously providing complete eye protection. Use of the "tent" drape, ultra-low particulate air filter, and betadine irrigation are also options that otologic surgeons may consider for additional safety.

Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic.

OBJECTIVE: Microscopic surgery is currently considered the 'gold standard' for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic. METHOD: Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively. RESULTS: Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training. CONCLUSION: The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.

Recommended Personal Protective Equipment for Cochlear Implant and Other Mastoid Surgery During the COVID-19 Era.

OBJECTIVES/HYPOTHESIS: The overall aim of this study was to evaluate personal protective equipment (PPE) that may facilitate the safe recommencement of cochlear implantation in the COVID-19 era, with the broader goal of minimizing the period of auditory deprivation in prelingually deaf children and reducing the risk of cochlear ossification in individuals following meningitis. METHODS: The study design comprised 1) an objective assessment of mastoid drilling-induced droplet spread conducted during simulated cochlear implant (CI) surgery and its mitigation via the use of a protective drape tent and 2) an evaluation of three PPE configurations by otologists while performing mastoid drilling on ex vivo temporal bones. The various PPE solutions were assessed in terms of their impact on communication, vital physiological parameters, visual acuity and fields, and acceptability to surgeons using a systematic risk-based approach. RESULTS: Droplet spread during simulated CI surgery extended over 2 m, a distance greater than previously reported. A drape tent significantly reduced droplet spread. The ensemble of a half-face mask and safety spoggles (foam lined safety goggles) had consistently superior performance across all aspects of clinical usability. All other PPE options were found to substantially restrict the visual field, making them unsafe for microsurgery. CONCLUSIONS: The results of this preclinical study indicate that the most viable solution to enable the safe conduct of CI and other mastoid surgery is a combination of a filtering facepiece (FFP3) mask or half-face respirator with safety spoggles as PPE. Prescription spoggles are an option for surgeons who need to wear corrective glasses to operate. A drape tent reduces droplet spread. A multicenter clinical trial to evaluate the effectiveness of PPE should be the next step toward safely performing CI surgery during the COVID-19 era. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2693-2699, 2020.