Lasers in endoscopic middle ear surgery: where do we stand today?

Area of Science:

• Otolaryngology
• Surgical Technology
• Medical Optics

Background:

• Endoscopic middle ear surgery (EES) offers minimally invasive access to middle ear structures.
• The integration of laser technology aims to enhance precision and safety in EES.

Purpose of the Study:

• To review the current status and applications of combining lasers with endoscopes in middle ear surgery.
• To evaluate the benefits and safety of laser-assisted EES.

Main Methods:

• A comprehensive literature search of PubMed (1975-2020) was conducted.
• Included clinical studies reporting the combined use of lasers and endoscopes in middle ear surgery.
• Excluded non-human and purely experimental studies.

Main Results:

• Publications on laser-assisted EES have increased since 2013 for pediatric and adult patients.
• Applications include cholesteatoma, chronic otitis media, ossicular fixation, otosclerosis, and tympanic paraganglioma.
• Advantages include improved hemostasis, non-contact tissue ablation, and precise manipulation around delicate structures like the stapes footplate.

Conclusions:

• Endoscopic ear surgeons are increasingly adopting lasers for specific tasks in middle ear surgery.
• Laser instruments are easily integrated with endoscopes, even for pediatric procedures.
• Laser ablation offers bloodless, non-contact tissue removal, potentially offsetting the challenges of single-handed endoscopic surgery with minimal complications when used properly.