High definition endoscopic ear surgery (EES) redefines traditional middle ear anatomical perspectives. The surgeon can observe in situ anatomical relationships with angled objectives in a way that the traditional microscopic view, with step-wise removal of structures is unable to achieve. The identical surgical view for both operator and observer lends itself to confident teaching.
The strength of endoscopic ear surgery (EES) is that it allows high definition visualisation of middle ear anatomy in an in situ and intact way. When compared with the operating microscope, what is truly unique is that the objective lens is placed within the ear canal or middle ear, which allows for an all-encompassing view during surgery. There is a very broad width and depth of field as well as a high optical zoom – allowing even individual clusters of blood cells to be seen coursing through capillaries on the promontory.
The endoscopic perspective redefines and reimagines the surgical anatomy allowing a better understanding of the disease / anatomy relationship. In contrast, the traditional microscopic method relies on removal of significant amounts of normal bone and soft tissue, often with removal of intact structures to fully observe the disease extent. While some cases will continue to suit a microscopic, or combined microscopicendoscopic approach, this extra dissection can be avoided in many cases. Additionally, the live image used by the surgeon is the same one that everyone else –surgical trainees, medical students, anaesthetic staff and nursing staff – is observing.
This simultaneous viewing dramatically increases engagement and interest in the surgical procedure from all present in the operating room. In the apprenticeship model of surgical training the identical surgical view allows the trainee to visualise the exact steps their mentor is performing. Conversely, when the trainee gains experiential learning through performing a procedure themselves, the mentor is able to supervise and follow their progress closely. The confidence in the view of the surgical anatomy that the mentor can achieve obviates the all too familiar phrase that otology trainees dread: “Let me take over for a second, I can’t really see what you’re doing”. Furthermore, the ability to record this video allows for retrospective review and reinforcement for those present at the surgery. By extension, this same all-encompassing video can be edited,overlayed with descriptors, pointers and information and used for future teaching and education. In the field of video otology tutorials, the identical operative and teaching view with the ability to overlay learning points certainly changes the game. Traditional teaching methods such as temporal bone dissection, concentrate on drilling techniques of the mastoid cavity with relative ignorance of the complex anatomical structures of the middle ear. The endoscopic approach shifts the trainee’s focus immediately to the tympanic membrane, ligaments and membranous folds of the attic and hidden spaces of the mesotympanum, instilling the importance of such structures in disease pathogenesis.