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Maximising efficiency with exoscopic surgery: a versatile approach for transoral laryngeal and oropharyngeal
Filippo Marchi1,2,3, Elisa Bellini1,2,3, Alessandro Ioppi2,3,4
1IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Objectives:
Several devices have been developed to improve head and neck surgery. 3D exoscopes provide surgeons a viable alternative to microscopes. We propose our setting for transoral exoscopic oropharyngeal (TOEOS) and transoral exoscopic laryngeal surgery (TOELS).
Methods:
A case series of patients treated with the exoscopic setup at the Otolaryngology Unit of IRCCS San Martino Hospital, Genoa, is presented. Our surgical setup and surgical and oncological outcomes are described.
Results:
Among 40 patients undergoing TOELS for glottic and supraglottic tumours, negative superficial and deep margins were achieved in 79.2% and 75% of patients, respectively. The mean operative time was 73.7 ± 35.9 minutes. Fourteen patients were treated by TOEOS and in only one case was re-resection required due to a positive deep margin. The mean operative time for TOEOS was 140.3 ± 82.1 minutes and the average duration of hospitalisation was 10.3 ± 3.8 days.
Conclusions:
3D exoscopes improve visualisation of the surgical site in different environments and allow the use of multiple surgical instruments and lasers, easing transoral surgery. In addition, as the first surgeon's view is shared between the operatory room (OR) staff, the exoscopic setup plays a crucial role in the collaboration between the OR team and for teaching purposes.
