Endoscopic approach: advantages and disadvantages
Compared with surgical microscope, surgical endoscope provides a closer
surgical field of vision, which makes it easier to expose the hidden
lesions of the middle ear. The visualization of middle ear can be better
realized by EES, especially when it is used for educational purposes.
Endoscopic approach is the primary surgical approach for middle ear
cholesteatoma, and Marchioni et al. It is easier to retain small bones
and completely remove cholesteat11 tumor in endoscopic
surgery. The scope of endoscopic surgery is obviously reduced, and there
is no obvious difference between the recurrence rate of cholesteatoma
and endoscopic surgery, according to the conclusion of Ayache et
al.12 Compared with endoscopic approach, postoperative
pain is higher and healing is slower. 13In the
endoscopic group, the arch incision behind the ear was not used after
operation, and scars would not appear. These advantages were also
confirmed in our study.
The one-handed technique of EES is perceived as one of its major
limitations. The main function of non-dominant hand in MES is to attract
the blood from the operation field, and it is the dominant hand to
perform important surgical stripping. In EES, only one hand can perform
the surgeries while the other hand controls the endoscopy, and a little
bleeding may interfere with the surgical field at this time. Therefore,
in the setting of one-handed surgical technique, hemostasis is
essential.
Depth perception is limited in EES due to the two-dimensional nature of
operation image, which is another obvious disadvantage in EES, so
operators are always faced with lack of stereoscopic vision. Therefore,
the surgeon has to achieve depth perception through haptic and visual.
Recently years, inquire depth perception has been overcome in functional
endoscopic sinus surgery; thus, we can learn from the experiences of
sinus surgeons and accommodate for the lack of perception of depth.