Treffer: Exoscope and Microscope Show Equivalence in Operative Times and Outcomes for Microlaryngeal Surgery.
Title:
Exoscope and Microscope Show Equivalence in Operative Times and Outcomes for Microlaryngeal Surgery.
Authors:
Mehdi Z; Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA., Kibel V; Texas A&M University School of Medicine, Texas A&M University Health Science Center, Houston, Texas, USA., Momin N; University of Texas Medical Branch, Galveston, Texas, USA., Majeethia H; Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA., Yiu Y; Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA.
Source:
The Laryngoscope [Laryngoscope] 2025 Nov; Vol. 135 (11), pp. 4272-4278. Date of Electronic Publication: 2025 Jul 01.
Publication Type:
Journal Article; Comparative Study
Language:
English
Journal Info:
Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8607378 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-4995 (Electronic) Linking ISSN: 0023852X NLM ISO Abbreviation: Laryngoscope Subsets: MEDLINE
Imprint Name(s):
Publication: <2009- >: Philadelphia, PA : Wiley-Blackwell
Original Publication: St. Louis, Mo. : [s.n., 1896-
Original Publication: St. Louis, Mo. : [s.n., 1896-
MeSH Terms:
Microsurgery*/instrumentation , Microsurgery*/methods , Operative Time* , Microscopy*/instrumentation , Larynx*/surgery , Laryngeal Diseases*/surgery , Laryngoscopy*/instrumentation , Laryngoscopy*/methods, Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Voice Quality ; Aged ; Treatment Outcome ; Adult ; Vocal Cords/surgery
References:
P. M. Pestana, S. Vaz‐Freitas, and M. C. Manso, “Prevalence of Voice Disorders in Singers: Systematic Review and Meta‐Analysis,” Journal of Voice 31, no. 6 (2017): 722–727, https://doi.org/10.1016/j.jvoice.2017.02.010.
M. N. Huston, I. Puka, and M. R. Naunheim, “Prevalence of Voice Disorders in the United States: A National Survey,” Laryngoscope 134, no. 1 (2024): 347–352, https://doi.org/10.1002/lary.30929.
N. Bhattacharyya, “The Prevalence of Voice Problems Among Adults in the United States,” Laryngoscope 124, no. 10 (2014): 2359–2362, https://doi.org/10.1002/lary.24740.
S. M. Cohen, J. Kim, N. Roy, C. Asche, and M. Courey, “Direct Health Care Costs of Laryngeal Diseases and Disorders,” Laryngoscope 122 (2012): 1582–1588.
S. M. Cohen, J. Kim, N. Roy, C. Asche, and M. Courey, “The Impact of Laryngeal Disorders on Work‐Related Dysfunction,” Laryngoscope 122 (2012): 1589–1594.
N. Roy, R. M. Merrill, S. Thibeault, S. D. Gray, and E. M. Smith, “Voice Disorders in Teachers and the General Population: Effects on Work Performance, Attendance, and Future Career Choices,” Journal of Speech, Language, and Hearing Research 47 (2004): 542–551.
W. R. Leeper, K. Fung, P. G. Beaudin, and P. C. Doyle, “Voice‐Related Quality of Life in Patients With Benign Vocal Fold Lesions,” Journal of Otolaryngology‐Head & Neck Surgery 37, no. 3 (2008): 423–429.
P. H. Wu and C. T. Wang, “Risk Factors for Postoperative Vocal Fold Fibrosis Following Microlaryngeal Surgery,” Laryngoscope Investigative Otolaryngology 8, no. 5 (2023): 1324–1327, https://doi.org/10.1002/lio2.1152.
R. H. Martins, H. A. do Amaral, E. L. Tavares, M. G. Martins, T. M. Gonçalves, and N. H. Dias, “Voice Disorders: Etiology and Diagnosis,” Journal of Voice 30, no. 6 (2016): e1–e9, https://doi.org/10.1016/j.jvoice.2015.09.017.
C. Carlucci, L. Fasanella, and A. Ricci Maccarini, “Exolaryngoscopy: A New Technique for Laryngeal Surgery,” Acta Otorhinolaryngologica Italica 32, no. 5 (2012): 326–328.
A. Hafez, R. H. L. Haeren, J. Dillmann, A. Laakso, M. Niemelä, and M. Lehecka, “Comparison of Operating Microscope and Exoscope in a Highly Challenging Experimental Setting,” World Neurosurgery 147 (2021): e468–e475, https://doi.org/10.1016/j.wneu.2020.12.093.
R. T. Sataloff, M. J. Hawkshaw, V. Divi, and Y. D. Heman‐Ackah, “Voice Surgery,” Otolaryngologic Clinics of North America 40, no. 5 (2007): 1151–1183, https://doi.org/10.1016/j.otc.2007.05.015.
L. Ricciardi, K. L. Chaichana, A. Cardia, et al., “The Exoscope in Neurosurgery: An Innovative “Point of View”. A Systematic Review of the Technical, Surgical, and Educational Aspects,” World Neurosurgery 124 (2019): 136–144, https://doi.org/10.1016/j.wneu.2018.12.202.
A. De Virgilio, A. Costantino, G. Mercante, et al., “High‐Definition 3‐D Exoscope for Micro‐Laryngeal Surgery: A Preliminary Clinical Experience in 41 Patients,” Annals of Otology, Rhinology, and Laryngology 131, no. 11 (2022): 1261–1266, https://doi.org/10.1177/00034894211063741.
V. D. Palumbo, S. Fazzotta, G. Damiano, and A. I. Lo Monte, “VITOM 3D System in Surgeon Microsurgical Vascular Training: Our Model and Experience,” Journal of Vascular Access 19 (2018): 108–109.
F. I. Ahmad, A. F. Mericli, M. V. DeFazio, et al., “Application of the ORBEYE Three‐Dimensional Exoscope for Microsurgical Procedures,” Microsurgery 40, no. 4 (2020): 468–472.
Y. Ichikawa, D. Senda, Y. Shingyochi, and H. Mizuno, “Potential Advantages of Using Three‐Dimensional Exoscope for Microvascular Anastomosis in Free Flap Transfer,” Plastic and Reconstructive Surgery 144, no. 4 (2019): 726–727.
A. De Virgilio, A. Costantino, T. Mondello, et al., “Pre‐Clinical Experience With the VITOM 3D and the ARTip Cruise System for Micro‐Laryngeal Surgery,” Laryngoscope 131, no. 1 (2021): 136–138, https://doi.org/10.1002/lary.28675.
H. N. C. Eckel, A. Nolte, M. S. Otte, et al., “3D‐Exoscopic Microlaryngoscopy in Phonosurgery for Glottic Insufficiency,” European Archives of Oto‐Rhino‐Laryngology 281 (2024): 855–861, https://doi.org/10.1007/s00405‐023‐08345‐7.
S. Takahashi, M. Toda, M. Nishimoto, et al., “Pros and Cons of Using ORBEYE for Microneurosurgery,” Clinical Neurology and Neurosurgery 174 (2018): 57–62, https://doi.org/10.1016/j.clineuro.2018.09.010.
J. Iqbal, M. M. Covell, S. Jabeen, et al., “Comparative Analysis of Exoscope‐Assisted Spine Surgery Versus Operating Microscope: A Systematic Review,” World Neurosurgery X 21 (2023): 100258, https://doi.org/10.1016/j.wnsx.2023.100258.
S. Smith, E. D. Kozin, V. V. Kanumuri, et al., “Initial Experience With 3‐Dimensional Exoscope‐Assisted Transmastoid and Lateral Skull Base Surgery,” Otolaryngology and Head and Neck Surgery 160, no. 2 (2019): 364–367.
P. K. Frykman, A. L. Freedman, T. D. Kane, Z. Cheng, M. Petrosyan, and K. Catchpole, “A Study of VITOM in Pediatric Surgery and Urology: Evaluation of Technology Acceptance and Usability by Operating Team and Surgeon Musculoskeletal Discomfort,” Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A 27, no. 2 (2017): 191–196.
F. Pirola, A. De Virgilio, A. Di Maria, et al., “Applying the Exoscope to Lacrimal Surgery: Preliminary Experience,” ORL: Journal for Otorhinolaryngology and Its Related Specialties 83, no. 5 (2021): 381–386.
T. Sanuki, N. Takemoto, S. Sumiya, and S. Iwasaki, “Preliminary Experience With 3‐Dimensional Exoscope‐Assisted Laryngoplasty,” Laryngoscope 134 (2024): 1813–1819, https://doi.org/10.1002/lary.31086.
C. P. Childers and M. Maggard‐Gibbons, “Understanding Costs of Care in the Operating Room,” JAMA Surgery 153, no. 4 (2018): e176233, https://doi.org/10.1001/jamasurg.2017.6233.
F. Dexter and R. E. Wachtel, “Economic Considerations in the Organization of Anesthesia and Surgical Services,” Anesthesiology 110, no. 3 (2009): 559–565, https://doi.org/10.1097/ALN.0b013e318194b6c1.
M. J. Scott, T. E. Miller, and W. J. Fawcett, “Principles and Practice of Enhanced Recovery After Surgery (ERAS),” Anaesthesia 70, no. 6 (2015): 781–785, https://doi.org/10.1111/anae.13000.
H. Kehlet and D. W. Wilmore, “Evidence‐Based Surgical Care and the Evolution of Fast‐Track Surgery,” Annals of Surgery 248, no. 2 (2008): 189–198, https://doi.org/10.1097/SLA.0b013e31817f2c1a.
C. Bianchini, C. Aimoni, and A. Ciorba, “Advances in Minimally Invasive Surgical Techniques in Otolaryngology,” Current Opinion in Otolaryngology & Head and Neck Surgery 21, no. 6 (2013): 477–482, https://doi.org/10.1097/MOO.0000000000000015.
E. Bartkowiak, Ł. Łuczewski, J. T. Chou, and M. Wierzbicka, “Is the 3D Exoscope Better Than the Surgical Microscope in Parotid Surgery: A Prospective, Randomized Single‐Center Study,” European Archives of Oto‐Rhino‐Laryngology 279, no. 2 (2022): 1029–1034, https://doi.org/10.1007/s00405‐021‐06876‐5.
N. L. A. Nawabi, B. F. Saway, C. Cunningham, et al., “Intraoperative Performance With the Exoscope in Spine Surgery: An Institutional Experience,” World Neurosurgery 182 (2024): 208–213, https://doi.org/10.1016/j.wneu.2023.12.004.
M. N. Huston, I. Puka, and M. R. Naunheim, “Prevalence of Voice Disorders in the United States: A National Survey,” Laryngoscope 134, no. 1 (2024): 347–352, https://doi.org/10.1002/lary.30929.
N. Bhattacharyya, “The Prevalence of Voice Problems Among Adults in the United States,” Laryngoscope 124, no. 10 (2014): 2359–2362, https://doi.org/10.1002/lary.24740.
S. M. Cohen, J. Kim, N. Roy, C. Asche, and M. Courey, “Direct Health Care Costs of Laryngeal Diseases and Disorders,” Laryngoscope 122 (2012): 1582–1588.
S. M. Cohen, J. Kim, N. Roy, C. Asche, and M. Courey, “The Impact of Laryngeal Disorders on Work‐Related Dysfunction,” Laryngoscope 122 (2012): 1589–1594.
N. Roy, R. M. Merrill, S. Thibeault, S. D. Gray, and E. M. Smith, “Voice Disorders in Teachers and the General Population: Effects on Work Performance, Attendance, and Future Career Choices,” Journal of Speech, Language, and Hearing Research 47 (2004): 542–551.
W. R. Leeper, K. Fung, P. G. Beaudin, and P. C. Doyle, “Voice‐Related Quality of Life in Patients With Benign Vocal Fold Lesions,” Journal of Otolaryngology‐Head & Neck Surgery 37, no. 3 (2008): 423–429.
P. H. Wu and C. T. Wang, “Risk Factors for Postoperative Vocal Fold Fibrosis Following Microlaryngeal Surgery,” Laryngoscope Investigative Otolaryngology 8, no. 5 (2023): 1324–1327, https://doi.org/10.1002/lio2.1152.
R. H. Martins, H. A. do Amaral, E. L. Tavares, M. G. Martins, T. M. Gonçalves, and N. H. Dias, “Voice Disorders: Etiology and Diagnosis,” Journal of Voice 30, no. 6 (2016): e1–e9, https://doi.org/10.1016/j.jvoice.2015.09.017.
C. Carlucci, L. Fasanella, and A. Ricci Maccarini, “Exolaryngoscopy: A New Technique for Laryngeal Surgery,” Acta Otorhinolaryngologica Italica 32, no. 5 (2012): 326–328.
A. Hafez, R. H. L. Haeren, J. Dillmann, A. Laakso, M. Niemelä, and M. Lehecka, “Comparison of Operating Microscope and Exoscope in a Highly Challenging Experimental Setting,” World Neurosurgery 147 (2021): e468–e475, https://doi.org/10.1016/j.wneu.2020.12.093.
R. T. Sataloff, M. J. Hawkshaw, V. Divi, and Y. D. Heman‐Ackah, “Voice Surgery,” Otolaryngologic Clinics of North America 40, no. 5 (2007): 1151–1183, https://doi.org/10.1016/j.otc.2007.05.015.
L. Ricciardi, K. L. Chaichana, A. Cardia, et al., “The Exoscope in Neurosurgery: An Innovative “Point of View”. A Systematic Review of the Technical, Surgical, and Educational Aspects,” World Neurosurgery 124 (2019): 136–144, https://doi.org/10.1016/j.wneu.2018.12.202.
A. De Virgilio, A. Costantino, G. Mercante, et al., “High‐Definition 3‐D Exoscope for Micro‐Laryngeal Surgery: A Preliminary Clinical Experience in 41 Patients,” Annals of Otology, Rhinology, and Laryngology 131, no. 11 (2022): 1261–1266, https://doi.org/10.1177/00034894211063741.
V. D. Palumbo, S. Fazzotta, G. Damiano, and A. I. Lo Monte, “VITOM 3D System in Surgeon Microsurgical Vascular Training: Our Model and Experience,” Journal of Vascular Access 19 (2018): 108–109.
F. I. Ahmad, A. F. Mericli, M. V. DeFazio, et al., “Application of the ORBEYE Three‐Dimensional Exoscope for Microsurgical Procedures,” Microsurgery 40, no. 4 (2020): 468–472.
Y. Ichikawa, D. Senda, Y. Shingyochi, and H. Mizuno, “Potential Advantages of Using Three‐Dimensional Exoscope for Microvascular Anastomosis in Free Flap Transfer,” Plastic and Reconstructive Surgery 144, no. 4 (2019): 726–727.
A. De Virgilio, A. Costantino, T. Mondello, et al., “Pre‐Clinical Experience With the VITOM 3D and the ARTip Cruise System for Micro‐Laryngeal Surgery,” Laryngoscope 131, no. 1 (2021): 136–138, https://doi.org/10.1002/lary.28675.
H. N. C. Eckel, A. Nolte, M. S. Otte, et al., “3D‐Exoscopic Microlaryngoscopy in Phonosurgery for Glottic Insufficiency,” European Archives of Oto‐Rhino‐Laryngology 281 (2024): 855–861, https://doi.org/10.1007/s00405‐023‐08345‐7.
S. Takahashi, M. Toda, M. Nishimoto, et al., “Pros and Cons of Using ORBEYE for Microneurosurgery,” Clinical Neurology and Neurosurgery 174 (2018): 57–62, https://doi.org/10.1016/j.clineuro.2018.09.010.
J. Iqbal, M. M. Covell, S. Jabeen, et al., “Comparative Analysis of Exoscope‐Assisted Spine Surgery Versus Operating Microscope: A Systematic Review,” World Neurosurgery X 21 (2023): 100258, https://doi.org/10.1016/j.wnsx.2023.100258.
S. Smith, E. D. Kozin, V. V. Kanumuri, et al., “Initial Experience With 3‐Dimensional Exoscope‐Assisted Transmastoid and Lateral Skull Base Surgery,” Otolaryngology and Head and Neck Surgery 160, no. 2 (2019): 364–367.
P. K. Frykman, A. L. Freedman, T. D. Kane, Z. Cheng, M. Petrosyan, and K. Catchpole, “A Study of VITOM in Pediatric Surgery and Urology: Evaluation of Technology Acceptance and Usability by Operating Team and Surgeon Musculoskeletal Discomfort,” Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A 27, no. 2 (2017): 191–196.
F. Pirola, A. De Virgilio, A. Di Maria, et al., “Applying the Exoscope to Lacrimal Surgery: Preliminary Experience,” ORL: Journal for Otorhinolaryngology and Its Related Specialties 83, no. 5 (2021): 381–386.
T. Sanuki, N. Takemoto, S. Sumiya, and S. Iwasaki, “Preliminary Experience With 3‐Dimensional Exoscope‐Assisted Laryngoplasty,” Laryngoscope 134 (2024): 1813–1819, https://doi.org/10.1002/lary.31086.
C. P. Childers and M. Maggard‐Gibbons, “Understanding Costs of Care in the Operating Room,” JAMA Surgery 153, no. 4 (2018): e176233, https://doi.org/10.1001/jamasurg.2017.6233.
F. Dexter and R. E. Wachtel, “Economic Considerations in the Organization of Anesthesia and Surgical Services,” Anesthesiology 110, no. 3 (2009): 559–565, https://doi.org/10.1097/ALN.0b013e318194b6c1.
M. J. Scott, T. E. Miller, and W. J. Fawcett, “Principles and Practice of Enhanced Recovery After Surgery (ERAS),” Anaesthesia 70, no. 6 (2015): 781–785, https://doi.org/10.1111/anae.13000.
H. Kehlet and D. W. Wilmore, “Evidence‐Based Surgical Care and the Evolution of Fast‐Track Surgery,” Annals of Surgery 248, no. 2 (2008): 189–198, https://doi.org/10.1097/SLA.0b013e31817f2c1a.
C. Bianchini, C. Aimoni, and A. Ciorba, “Advances in Minimally Invasive Surgical Techniques in Otolaryngology,” Current Opinion in Otolaryngology & Head and Neck Surgery 21, no. 6 (2013): 477–482, https://doi.org/10.1097/MOO.0000000000000015.
E. Bartkowiak, Ł. Łuczewski, J. T. Chou, and M. Wierzbicka, “Is the 3D Exoscope Better Than the Surgical Microscope in Parotid Surgery: A Prospective, Randomized Single‐Center Study,” European Archives of Oto‐Rhino‐Laryngology 279, no. 2 (2022): 1029–1034, https://doi.org/10.1007/s00405‐021‐06876‐5.
N. L. A. Nawabi, B. F. Saway, C. Cunningham, et al., “Intraoperative Performance With the Exoscope in Spine Surgery: An Institutional Experience,” World Neurosurgery 182 (2024): 208–213, https://doi.org/10.1016/j.wneu.2023.12.004.
Contributed Indexing:
Keywords: 3D exoscope; microlaryngeal surgery; microlaryngoscopy; operating microscope; phonomicrosurgery
Entry Date(s):
Date Created: 20250701 Date Completed: 20251125 Latest Revision: 20251125
Update Code:
20251125
DOI:
10.1002/lary.32374
PMID:
40590437
Database:
MEDLINE
Weitere Informationen
Objectives: Newer optical systems such as 3D exoscopes are now being utilized for magnification and visualization in surgical fields like neurosurgery and otolaryngology. We seek to compare operative times and clinical outcomes between the operating exoscope (OE) and traditional operating microscopes (OM) for microlaryngeal surgery (MLS).
Methods: We conducted a retrospective, single-center review of patients who underwent MLS from 2019 to 2024 using the OE or OM, comparing operative times and voice outcome measures including patient subjective vocal quality, OMNI vocal effort, and GRBAS scales.
Results: Eighty-four (45 OE and 39 OM) patients underwent MLS for primarily phonotraumatic vocal fold lesions. There were no statistically significant differences in operative time (in minutes) between OE versus OM cohorts: setup time (22 vs. 21, p value = 0.54), procedure length (46 vs. 49, p = 0.45), and total patient time in OR (83 vs. 86, p = 0.57). There were no significant differences in pre-operative voice assessments between the OE and OM cohorts. There were also no significant differences in post-operative (4-6 weeks) subjective vocal quality (7.8 vs. 7.5, p = 0.57), OMNI vocal effort (3.1 vs. 3.9, p = 0.28), or GRBAS scale (G: 0.80 vs. 0.85, p = 0.74; R: 0.82 vs. 0.72, p = 0.46; B: 0.26 vs. 0.41, p = 0.24; A: 0.18 vs. 0.10, p = 0.36; S: 0.56 vs. 0.51, p = 0.75). There were no serious intraoperative or postoperative complications in either cohort.
Conclusion: This is the first study directly comparing the OE to the OM in MLS. Our findings demonstrate non-inferiority of the OE compared to the OM for operative times and voice outcomes.
(© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)