Augmented Reality-Assisted Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

Area of Science:

• Otolaryngology
• Surgical Technology
• Medical Imaging

Background:

• Transcanal endoscopic ear surgery (TEES) indications for middle ear cholesteatoma now include mastoid extension.
• Predicting external auditory canal (EAC) removal extent for cholesteatoma resection remains challenging.
• TEES is not universally indicated for all cholesteatoma cases with mastoid extension.

Purpose of the Study:

• To utilize augmented reality (AR) for intraoperative lesion projection.
• To predict external auditory canal (EAC) removal requirements.
• To guide the selection of an appropriate surgical approach for cholesteatoma.

Main Methods:

• Patients with mastoid extension underwent surgery using an AR-equipped navigation system.
• Augmented reality projected the cholesteatoma lesion onto intraoperative endoscopic images.
• Surgical approach was selected based on predicted EAC removal needs.

Main Results:

• Lesions slightly extending into the antrum necessitated extensive EAC resection.
• Lesions throughout the antrum allowed for smaller EAC resection, favoring TEES.
• AR projection accurately guided EAC removal extent prediction.

Conclusions:

• Predicting EAC removal extent aids in choosing between TEES and canal wall-up mastoidectomy.
• This approach optimizes preservation of the EAC.
• Findings support successful middle ear surgery and future robotic surgery implementation.