Distal Chip Micro-Endoscope for Middle Ear Surgery – Initial Experience in Human Cadaveric Temporal Bones

By June 7, 2019

Knoll, Renata M.1,2; Kozin, Elliott D.1,2;Remenschneider, Aaron K.1,2,3
1 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA;
2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA;
3 Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, MA USA;

Endoscopic ear surgery (EES) is widely recognized for the wide and high-resolution view of the middle ear (ME). Rigid endoscopes attached to high definition (HD) CCD cameras are most commonly used to obtain such views. However, the ergonomics and need for single handed dissection with rigid scopes make adoption of endoscopic approaches challenging. Recent technology advancements now facilitated the design of a distal chip micro endoscope (DCME) with ergonomics of traditional otology instruments.

Two cadaveric ME dissections were performed using a novel endoscopic ear platform (ColibriTMMicro ENT Scope) which includes an integrated drivable suction alongside standard otologic instruments. Increasingly complex tasks from ventilation tube placement to incudostapedial joint separation to placement of ossicular replacement prostheses were performed. Visualization of the tympanic recesses was also performed. Image quality, visualization and ergonomics were assessed.

All tasks were successfully performed, with a relatively steep learning curve to reach proficiency. When compared to a 3mm rigid endoscope, the DCME HD-CCD camera image quality was adequate but not superior. Ergonomics were significantly better, and manipulation of a second instrument was not impeded by the endoscope. The addition of a built-in suction to the micro-endoscope facilitated simultaneous suction and dissection using two hands.

DCME may be employed for the creation of an ergonomically favorable for ME dissection. The addition of a suction port facilitates two handed dissection, which may eliminate a major drawback of current rigid endoscopic techniques. Further study of DCME is needed to understand their role in EES.