The utility of the exoscope compared to the operating microscope in simulated temporal bone surgery

Abstract

Objective: To objectively assess the utility of an exoscope during simulated otological surgery.

Design: Cohort study.

Setting: Tertiary referral otolaryngology centre.

Participants: Seven experienced otologists undertook simulated temporal bone surgery on plastic temporal bones using the Zeiss Kinevo microscope with both a microscope and exoscope facility.

Outcome measures: The utility of microscope and exoscope was compared using a Likert scale from 1 to 10 with and without PPE. Attributes assessed included image quality, depth perception, adequacy of view, exoscope positioning, surgeon comfort, surgeon safety and adequacy of image and protection for assistants and observers.

Results: The exoscope in 3D mode performed as well as or better than the microscope for image quality, field of view and manoeuvrability. It outperformed the microscope for compatibility with PPE, surgeon comfort and assistant/observer experience. It scored almost as highly as the microscope for depth perception.

Conclusion: There is likely to be a learning curve but this initial assessment of the exoscope shows significant potential as an alternative to the operating microscope in otological surgery but with the advantage of allowing the use of appropriate PPE and better ergonomics for both surgeon and assistant/observer.

Keywords: COVID; ear surgery; exoscope; personal protective equipment; temporal bone.