KEY POINTS
  1. This is the first study to use a qualitative methodology to assess the potential advantages and disadvantages of the application of 3D endoscopes in pediatric otolaryngology surgery.
  2. Open-ended, structured interviews were conducted with six pediatric Otolaryngologist operating at a tertiary pediatric centre, with a minimum one year of experience using a 3D endoscopy system.
  3. Thematic analysis of the surgeon’s responses identified 3D endoscopy to provide improved surgical field visualization which thus served as a valuable teaching tool.
  4. The surgeons interviewed found 3D endoscopy to improve surgical outcomes in pediatric airway surgery, particularly in surgeries involving the larynx.
  5. Further quantitative evaluation of patient outcomes could delineate the precise clinical role 3D endoscopy may hold in future pediatric Otolaryngology practice.
INTRODUCTION
Three-dimensional (3D) endoscopy has emerged as a surgical tool to improve visualization and stereoscopic vision in Otolaryngologic surgery. The diameter of 3D endoscopes has been reduced to 4 mm, thereby allowing surgeons to better navigate narrow anatomy while continuing to reliably provide images of high quality and resolution. Early peer-reviewed evaluations of the novel surgical technique have not yielded a definitive consensus on 3D endoscopy’s utility in Otolaryngology. Three-dimensional endoscopy was found to provide enhanced visualization of the laryngeal structures which improved surgical excision1. In contrast, other reports have found no difference in clinical outcomes when using 3D over 2D endoscopy in sinus or middle ear surgeries, although 3D endoscopy provided notably improved anatomic visualization2,3. Despite the discordance, such quantitative research has been confined to experimental settings or specific clinical presentations, and has largely failed to evaluate 3D endoscopy use in regular clinical practice. This is the first study to use a qualitative methodology to assess the potential advantages and disadvantages of 3D endoscope use in pediatric Otolaryngology surgery as experienced by surgeons with regular access to 3D endoscopic technology.
METHODS
A qualitative study design was employed to obtain an in-depth and broad understanding of Otolaryngologists’ experiences with 3D endoscopy, focussing on clinical advantages and challenges that they faced when using the novel surgical equipment. A Karl Storz TipCam™ (Karl Storz GmbH & Co, Tuttlingen, Germany) second generation 3D-high-definition, 4mm endoscopy system (0 degree, 30 degree, 45 degree) was used by all participants with 3D glasses and appropriate personal protective equipment. The study was approved by the Research Ethic Board at British Columbia Children’s Hospital (BCCH). Written informed consent was obtained from all interview participants prior to their study participation. The study followed Standards for Reporting Qualitative Research (SRGR) guidelines.