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Updated: Sep 18, 2025

Endoscopic Cholesteatoma Surgery
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Improved Cholesteatoma Removal with CADISS: A Quantitative Ultrastructural Comparison Using VP-SEM.

Michela Relucenti1, Ubaldo Romeo Plastina1, Pasquale Fino2

  • 1Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Via Alfonso Borelli 50, 00161 Rome, Italy.

Journal of Clinical Medicine
|June 26, 2025
PubMed
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Chemically assisted dissection (CADISS) with Mesna significantly improves cholesteatoma removal from incus bone compared to manual dissection. This technique enhances surgical precision and reduces disease recurrence in middle ear surgery.

Area of Science:

  • Otolaryngology
  • Surgical Technology
  • Microscopy

Background:

  • Cholesteatoma is a destructive middle ear disease requiring meticulous surgical excision.
  • The chemically assisted dissection (CADISS) system utilizes Mesna (5%) to improve tissue separation and reduce residual disease.
  • Preserving auditory function and preventing recurrence are key surgical goals.

Purpose of the Study:

  • To quantitatively compare the cholesteatoma cleaning efficiency of CADISS-assisted dissection versus conventional manual dissection.
  • To evaluate residual cholesteatoma on incus bone surfaces using ultrastructural analysis.
  • To correlate surgical technique with postoperative residual disease and recurrence rates.

Main Methods:

  • Retrospective analysis of 67 human incus samples from cholesteatoma surgery.
Keywords:
VP-SEM imagingchemical-assisted dissectioncholesteatoma surgeryresidual disease

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  • Variable pressure scanning electron microscopy (VP-SEM) for ultrastructural imaging of hydrated samples.
  • Quantitative analysis of clean area/total area ratios and qualitative assessment of residuals.
  • Postoperative MRI follow-up at 1 month to detect residual cholesteatoma.

    • Main Results:

    • CADISS-assisted dissection yielded significantly higher clean area/total area ratios (0.2095 vs. 0.0478, p < 0.0001).
    • Qualitative imaging revealed fewer residual cholesteatoma fragments > 1 mm in the CADISS group (9% vs. 77%).
    • MRI follow-up showed a lower recurrence rate in the CADISS group (3.1%) compared to manual dissection (11.4%).

    Conclusions:

    • CADISS-assisted dissection offers superior cholesteatoma debris removal compared to manual techniques.
    • VP-SEM imaging and clinical outcomes support the efficacy of CADISS.
    • This method holds potential for improving surgical outcomes and reducing recurrence in middle ear cholesteatoma surgery.