Implications for practice
Appreciable image enhancement using 3D endoscopy translated into the surgeons’ ability to better delineate anatomical relationships. Notable pediatric clinical scenarios in which such delineation improved surgical experience was the larynx. In the instance of laryngeal papillomatosis, surgeons felt they could more safely perform an extensive resection of tissue and minimise airway traumatization due to improved confidence of the exact margin of disease. This thorough resection was found to double the interval between recurrent respiratory papillomatosis procedures. This finding builds upon previously defined benefits of 3D endoscopy for surgical treatment of laryngomalacia and subglottic cysts1,8. Similarly, three surgeons noted they were better able to visualize the borders of vocal cords in medialization procedures. In contrast, the current 3D endoscope technology is limited to 4 mm in diameter which restricted its use in narrow spaces including certain neonatal airways and pediatric middle ear spaces. Anecdotally, two surgeons noted the stereoscopic vision was lost when the camera lens was frequently soiled during sinus surgery. This finding contrasts previous reports of a well-defined role for 3D endoscopy in endonasal surgery, albeit in adult patients9.
Subjective surgeon experience of 3D endoscopy was improved with increased use. In particular, the initial technical challenges such as increased set-up time and equipment positioning optimization were overcome with experience. This is further evidenced by Moore and Bennett, who found 90% of endoscopic surgical complications to occur in the first 30 patients on the learning curve10. No adverse physical side effects were encountered by surgeons to limit their ability to perform the procedures in a safe and efficient manner. Altogether, the above findings encourage the continued use of 3D endoscopy, particularly in pediatric Otolaryngology airway surgery.