cutting-edge advances in endoscopic ear surgery · 2019. 9. 27. · p: protympanum, t: tympanic...
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Cutting-Edge Advances
in Endoscopic Ear SurgerySeiji Kakehata
Yamagata University, JAPAN
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I have nothing to disclose.Within the last 12 months I have not had any type of financial arrangement or
affiliation with commercial interests related to the content of this continuing education activity that requires disclosure.
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Transcanal Endoscopic Ear Surgery
Utilize the EAC as the natural corridor of the tympanic cavity and beyond
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Seeing Beyond What the Eye Can See
High resolutionWell beyondRetina
TranscanalEndoscopic Tympanoplasty
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Reach beyond your grasp
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6
Development of a new surgical procedure
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Non-slip Surface
Treatment Technology
Development of a new surgical procedure
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Side-by-side insertion
One-handed surgery
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Challenges of TEES
These disadvantages have limited the spread of this technique.
Challenges 1. 2D visualization2. One-handed surgery3. Difficulty in accessing the antrum4. Narrow EAC
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Challenges of TEES
These disadvantages have limited the spread of this technique.
Challenges 1. 2D visualization2. One-handed surgery3. Difficulty in accessing the antrum4. Narrow EAC
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Powered TEES
Incorporation of Powered Instruments
Kakehata, et al. Otol Neurotol. 2014
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➔
Indication for TEES has been expanded
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Retrograde Mastoidectomy (Inside-out)
Endoscopic
Mastoid preservation-gas exchange-buffer effect
requires considerably less bone removal than microscopic retrograde mastoidectomy.
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Ultrasonic Aspirator High-Speed Curved Bur
Powered Instruments for TEES
We are able to successfully perform “endoscopic retrograde mastoidectomy on demand” by using powered instruments.
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Ultrasonic Aspirator
The UA cuts bony tissue with no kicking or grabbing of the soft tissue.
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High-Speed Curved Bur
When irrigation and suction are required, an assistant handles the irrigation and suction.
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Chisel & Hammer
A chisel and hammer are also very effective in the TEES.The operator holds a chisel and an assistant use a hammer.
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EndoscopeHammer
Chisel
Two-handed surgery
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19
PSQCholesteatoma
TP IVi-M6 year-old boy
minor axis: 4.4mm
major axis: 7.7 mm
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Extending to the antrumbefore the Donaldson line
→ TEESExtending to the central mastoid beyond the Donaldson line
→ Dual Approach (CWU)
TEES+MESWith extracranial complications
→ MES (CWD)
Indications for TEES for Cholesteatoma
Exclusion criteria (TEES)
• Infiltrative cholesteatoma
• Large defect in tegmen
Divisions of the Middle Ear Space using PTAM system (The Japan Otological Society, 2010)
P: protympanum, T: tympanic cavity, A: attic, M: mastoid
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Divisions of the Middle Ear Space using PTAM system (The Japan Otological Society, 2010)
P: protympanum, T: tympanic cavity, A: attic, M: mastoid
Indications for TEES for Cholesteatoma
Exclusion criteria (TEES)
• Infiltrative cholesteatoma
• Large defect in tegmen
Antrum
Central
mastoid
Extending to the antrumbefore the Donaldson line
→ TEESExtending to the central mastoid beyond the Donaldson line
→ Dual Approach (CWU)
TEES+MESWith extracranial complications
→ MES (CWD)
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22
TEES Dual CWD+SWR CWD (open)
0% 20% 40% 60% 80% 100%
Stage I(n=26)
Stage II(n=61)
Stage III(n=17)
Pars flaccida
0% 20% 40% 60% 80% 100%
Stage I(n=6)
Stage II(n=15)
Stage III(n=8)
Pars tensa
90 of 133 cholesteatoma patients (68%) were treated by TEES
Surgical procedures and stages (PTAM) of cholesteatomas
(primary cases) (September 2011 - March 2015)
Stage I: Localized in the primary site
Stage II: Involving two or more sites
Stage III: With extracranial complications
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Chisel StraightCurved
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Non-slip Surface Treatment Technology
Development of surgical instruments
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Non-slip Surface Treatment Technology
Development of surgical instruments
Ultimate Diamond Carbon Nanotube coating
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Non-slip Surface Treatment Technology
Development of surgical instruments
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Forceps with non-slip surface treatment
technology
Does allow precise surgical procedure
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Development of a new surgical procedure
iArms is supposed to Make TEES more safe and more secureReduce the stress and fatigue of the surgeon.
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Evaluation of Camera Shake
Without iArms With iArms
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Evaluation of Camera Shake
Without iArms With iArms
0
20
40
60
80
100
120
140
160
180
3737.1 4404.4 5071.7 5739.1 6406.4
0
20
40
60
80
100
120
140
160
180
point 1point 2point 3
Moving Velocity
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The Goal of Transcanal Endoscopic Ear Surgery
Less Invasive
Functional
Secure & Safe
Under construction
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We still haven’t reached the top!Tremendous progress has been made in improving TEES
Our journey is not over
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