Drilling in Endoscopic Ear Surgery – the “Chopstick” Technique

By June 7, 2019

Vaughan, Casey1; Kong, Jonathan1,2.
1 Department of Otolaryngology, Royal Prince Alfred Hospital, Sydney, Australia;
2 Sydney Endoscopic Ear Surgery Research Group, Sydney, Australia.

Drilling with irrigation poses technical difficulties for the Endoscopic ear surgeon..  If drilling is required, some surgeons would advocate switching to a microscope to enable the use of both hands, which may require a post auricular or endaural incision to improve access and can increase operating time.  The “chopstick” technique described here is one method of overcoming this limitation and allowing the use of drilling with irrigation with one hand, increasing the scope of being able to perform otology procedures entirely endoscopically.

The operator holds the endoscope in one hand, and both the drill and the suction in the other hand, a similar technique to that of holding chopsticks.  This allows for pseudo-independent movement of the drill and suction in one hand.

This technique is an option to be used only in selective cases, however its advantage is that it allows an atticotomy or canalplasty to be achieved in a stepwise manner without switching over to a microscope. Attention needs to be paid by the surgeon of suction tip position in relation to the burr tip, and practice may be required in order for the surgeon to feel comfortable with two instruments in one hand, as per any learning curve.

The “chopstick” techniquecan be utilised for overcoming one handed operating in selected cases of endoscopic ear surgery to allow for drilling with both irrigation and suction. This potentially allows more cases to be performed entirely endoscopically, obviating the need for utilising a microscope and a post auricular incision, and increasing surgical convenience.