Preliminary experience with exoscope in lacrimal surgery
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Preliminary experience with exoscope in lacrimal surgery Francesca Pirola1,2 · Giuseppe Spriano1,2 · Luca Malvezzi1,2 Received: 2 May 2020 / Accepted: 15 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Endoscopic dacryocystorhinostomy (e-DCR) is the mainstay for lacrimal sac/duct conditions. The purpose is to investigate the role of the exoscope as assisting tool in e-DCR. Methods Primary endpoint were symptoms resolution (epiphora/dacryocystitis) and time for surgery. Qualitative features of the exoscope were analyzed: a questionnaire administered to the surgical team allowed to evaluate the perceived quality of this technology. Conclusions The exoscope is a new tool that may support e-DCR. It has comparable results on symptoms outcomes and time for surgery than classic e-DCR. This new technology was accepted by all team members and showed great teaching potential. Keywords Teaching · Endoscopic dacryocystorhinostomy · New technology in lacrimal surgery · Exoscope · Image magnification
Introduction Endoscopic dacryocystorhinostomy (e-DCR) is a well proven technique for cases of nasolacrimal duct obstruction (NLDO) [1, 2]. It established its significance as a comparable technique to external DCR (ex-DCR) in terms of controlling lacrimal sac infections (dacryocystitis) and epiphora. Compared to the ex-DCR, e-DCR has multiple advantages: it avoids the risk of cutaneous scarring, it has lower infection rates and the potential of prompt intervention in cases of mucopyocele [3, 4]. Some studies showed its superior results to ex-DCR in control of the epiphora because of sparing Jones lacrimal pump [4, 5]. In e-DCR, greater precision and bone preservation of the lateral nasal wall are allowed, as well as correction of anatomical variants in cases of concurrent sinonasal pathology [3]. In our experience in the Dept Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00405-020-06379-9) contains supplementary material, which is available to authorized users. * Francesca Pirola [email protected] 1
Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089 Milan, Italy
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
2
of ENT-HNS at Humanitas Research Hospital, we preliminarily studied the applicability of the exoscopic technology to DCR procedures, evaluating surgical outcomes, time for surgery, team members’ self-perception. The combined exoendoscopic view was also compared to endoscopy alone.
Relevant surgical anatomy The anatomy of the lateral nasal wall should be known and accurately studied in each case by means of thin-section CT scan, especially the projection of the uncinate process (UP) and the presence of endonasal anatomical variants.
Description of the technique The exoscope (VITOM® 2D/3D by Karl Storz, Tuttlingen, Germany) is a compact video micros
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