Key points - 3D exoscopy is an emerging visualisation technique designed to improve ergonomics and image quality during surgeries. - We present a novel application of the VITOM® 3D exoscope in cochlear implantation (IDEAL Stage 2a prospective case series). - The system enabled high-quality visualisation during both posterior tympanotomy and electrode insertion. - Both the chief surgeon and the staff members rated the ergonomics of the system highly. - 3D exoscopy is a useful alternative to conventional microscopy, but the two techniques remain to be directly compared in larger studies.