ENDOSCOPIC SURGERY AND ITS VARIOUS OPTIONS

Hideo Edamatsu, Mamiko Yasuda, Koji Matsushima, Kota Wada, Toshihito Suda

Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan

Objective

The merit of endoscopic-aided ear surgery is that endoscopic observation can give the otosurgeon a wide and clear view of the middle-ear cleft. Detailed observation can avoid an injury of the facial nerve or the inner ear. Moreover, endoscope can show a residual cholesteatoma under the ossicles or in the tympanic sinus where microscopic observation is limited (Figs. 1 and 2).

Therefore, an endoscope should be used more in ear surgery, not only for adults but also for children.

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Fig. 1. Endoscopic view of the middle ear. Endoscopic observation is excellent to get a wide and detailed view of the middle-ear cleft. This is a left ear with a perilymph fistel, so the anatomy is normal. With the endoscope, we have a clear and total view of stapes and facial nerve and tympanic sinus in one frame.

Methods, options and cases

Our basic style of ear surgery is that the surgeon holds an endoscope with 2.7 mm diameter and 17 cm length in the left hand and handles surgical tools in the right hand. Both devices are introduced into the middle ear through the external ear canal. Endoaural approach is preferable for minimally invasive surgery, both in adults and children.

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Fig. 2. Comparison of operative views of stapes, all in the same ear. a: surgical-mirror view; b: microscopic view; c: endoscopic view. The operative fields in (a) and (b) were very narrow and small compared with (c).

We have the following endoscopic options besides the basic one: 1) When both hands are necessary for the surgery, the endoscope self-holder (endoarm) is very useful (Fig. 3). The endoarm can sustain the endoscope in the external ear canal and the ear surgeon can use both hands for operating. A two-handed operation is required in cholesteatoma, glomus tumor and schwannoma, because suction and surgical tool must be used at the same time. 2) Fogging at the tip of endoscope might be very annoying. To prevent this problem, we have used the light source of the light emitted diode (LED) because this system produces no heat and consequently no fogging. 3) A high-definition fine visual system is also very useful to give a very bright and clear operative view compared with conventional monitoring (Fig. 4).

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Fig. 3. The endoarm, composed of a specific endoscope holder (b) and sustainer (c). The endoscope is set at the orifice of the external ear canal.

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Fig.4. Endoscopic stapes surgery. Stapes surgery is good indication for the endoarm. In clear operative view (a), both hands can be used to remove stapes (b), open the footplate, attach the wire piston (c), and place a fascia (d).

Good indications of endoscopic ear surgery are stapes surgery, tympanoplasty in adults and ossicular anomaly, congenital cholesteatoma in children.

Conclusion

Otosurgery is very dangerous to perform without adequate observation of stapes or facial nerve. Observation with an endoscope is a very useful way to find these structures, and it is possible in adult patients as well as in children (Table 1).

Table 1.

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Our conclusion is that safe, minimally invasive ear surgery should be performed both in adults and children with an endoscope.


Address for correspondence: Hideo Edamatsu, Department of Otolaryngology, Toho University School of Medicine, Tokyo, 1438541 Japan. edamatsu@med.toho-u.ac.jp

Cholesteatoma and Ear Surgery – An Update, pp. 191–193

Edited by Haruo Takahashi

2013 © Kugler Publications, Amsterdam, The Netherlands