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.