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.