Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England - 20 years on.

BACKGROUND: Flexible upper aerodigestive endoscopy is often performed in the emergency setting. To prevent nosocomial infection on-call clinicians must have access to decontaminated endoscopes. METHODS: A telephone survey of 104 ENT units in England replicated previous cycles conducted 10 and 20 years ago. The on-call clinician was asked about decontamination practices, training and cross-cover. RESULTS: Seventy-one clinicians participated of which 68 had an endoscope available out-of-hours. Twenty-five (36.8 per cent) used single-use endoscopes. Twenty-three (51.1 per cent) of the 45 clinicians using re-usable endoscopes decontaminated them themselves, an increase from 43.3 per cent in 2013 and from 35.1 per cent in 2002. Overall 91.2 per cent had safe practices, up from 68.7 per cent in 2013 and 48 per cent in 2002. One hundred per cent had been trained in decontamination, compared to 37.3 per cent in 2013 and 12.1 per cent in 2002. On-call clinicians from the ENT department increased to 91.5 per cent, compared to 63 per cent in 2013. CONCLUSION: There has been a dramatic increase in patient safety, underpinned by the introduction of single-use endoscopes, increased training and reduced cross-cover.

Breadth and Depth: Three-Dimensional Endoscopic Field of View: Two-Dimensional Versus Three-Dimensional Endoscopic Field of View.

BACKGROUND: Three-dimensional (3D) endoscopy is an emerging tool in ear-nose-throat (ENT) and skull base surgery with the benefit of providing real-time depth perception. Several investigators have reported that the field of view (FOV) is reduced in 3D endoscopes compared with regular 2-dimensional (2D) endoscopes. Thus, we objectively compared the FOV of 2D and 3D endoscopes. METHODS: Using a standard 2D and 2 different 3D ENT endoscopes, images were captured of 1-mm graph paper from a set distance of 6 cm. The FOV was calculated from these images and compared among the endoscopes. RESULTS: The VisionSense 3D endoscope had a slightly smaller FOV (9.1 cm vs. 10.1 cm; -9.9%), and the Karl Storz 3D endoscope showed a slightly larger FOV (10.4 cm vs. 10.1 cm; +3.0%). However, the results were complicated by the different-shaped images produced by the 3D endoscopes. CONCLUSION: The differences in the FOV between the 2D and 3D endoscopes used in ENT surgery were not clinically significant. Thus, the FOV should not be considered a limitation of 3D technology.

Three-dimensional endoscopy: The future of nasoendoscopic training.

OBJECTIVES/HYPOTHESIS: Three-dimensional (3D) endoscopy is an emerging tool in surgery that provides real-time depth perception. Its benefits have been investigated in surgical training, but the current literature lacks significant objective outcome data. We aimed to objectively compare the efficacy of two-dimensional (2D) versus 3D high-definition endoscopes in novice users. STUDY DESIGN: Prospective, randomized crossover study. METHODS: Ninety-two novice medical students who used both 2D and 3D endoscopes to complete two validated tasks in a box trainer participated in the study. Time taken and error rates were measured, and subjective data were collected. RESULTS: Wilcoxon tests showed 3D technology was significantly faster than 2D (78 vs. 95 seconds, P = .004), and errors per task were significantly lower (3 vs. 5, P < .001). Sixty-nine percent of participants preferred the 3D endoscope. CONCLUSIONS: 3D high-definition endoscopy could be instrumental in training the next generation of endoscopic surgeons. Further research is required in a clinical setting. LEVEL OF EVIDENCE: 2b Laryngoscope, 129:1280-1285, 2019.