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Toshiro Umezaki MD, PhD Department of Otolaryngology, Graduate School of Medical Sciences, Kyushu University, Japan

Email: umetoshi@qent.med.kyushu-u.ac.jpPhone: +81-92-642-5668Website:http://www.qent.med.kyushu-u.ac.jp/index.html

ObjectiveIn order to overcome the drawback of 2D

videolaryngoscopy, we have developed a newly devised 3D videolaryngoscope, and we evaluated the usefulness of this devise.

MethodsA 3D high vision camera of 5mm in diameter

was attached to a usual 2D laryngoscope. Real time images were monitored by a dome-shaped 3D monitor (Panasonic Health Care). We performed endolaryngeal microsurgery on some patients with voice disorders, and compared usefulness between 2D, 3D and conventional binocular system.

ResultsUsing 3D videolaryngoscope allowed better

and easier manipulation in grasping and cutting the lesion, and even in suturing the laryngeal mucosa because of its stereoscopic visual effect, as compared to 2D scope. In comparison to the conventional binocular microscopy, 3D videoscope offered equivalent stereoscopic imaging and an advantage in nearer positioning to the patient, bringing about accurate surgical operation.

ConclusionOur study indicates that 3D imaging offers

novel advantages in the performance of endolaryngeal microsurgical skills to every surgeon.

Newly Devised 3D Videolaryngoscopy for LaryngomicrosurgeryT. Umezaki, MD, PhD1; K. Adachi, MD1; S. Komune, MD, PhD1; K. Ohuchida, MD2; M. Hashizume MD, PhD 2

1Department of Otolaryngology, Graduate School of Medical Sciences, Kyushu University 2Department of Advanced Medical Initiatives, Kyushu University, Fukuoka, Japan

In recent years, endoscopic surgery using 3D endoscopes has beenreported to be useful in certain sinonasal and skull base surgeries. In the field of endolaryngeal microsurgery, however, 3D videolaryngoscopy has never reported. So we have developed a original 3D endoscope for laryngeal microsurgery. 3D endoscopy enables the surgeon improved depth of field and stereoscopic vision, and also brings about more accurate surgical procedures in the nearer position to the glottic lesion. Thus, the conventional binocular system can be replaced by 3D videolaryngoscopy in the near future, although the problem for laser surgery is remained to be solved.

A 3D high vision camera of 5mm in diameter (Shinkohkohki, Japan) was attached to a usual 2D laryngoscope. Real time images viewing laryngeal surgical field was monitored by a dome-shaped 3D monitor (Panasonic Health Care, Japan) without distortion of images. We performed endolaryngeal microsurgery on some patients with voicedisorders due to vocal folds polyps, nodules, keratosis or tumors, and compared usefulness between 3D endoscopic and conventional binocular system.

Our newly devised 3D videolaryngoscope enables us to do laryngomicrosurgery in a view of 3D images without a binocular microscope. This system is composed of the special 3D rigid scope with 2 optic channels, right and left, in a single body of 5mm in diameter (Fig. 1, left), and a special 3D Hivision camera (Fig. 1, right) and Panasonic 3D Hivision monitor (Fig. 2). The surgeon has to put on polarized glasses to obtain stereoview. The body of the 3D scope is held and controlled in the proper position by the special instrument, named “point-setter” (Fig. 3). Clinical use of this system is approved by our institutional review board.

We did endolaryngeal microsurgeries in 5 patients with glottic lesions using our new 3D endoscopic system (Table 1).

The authors do not have any conflicts of interest to declare.

This pilot study demonstrated the effectiveness of our 3D videolaryngoscopy during endolaryngeal microsurgery.

We found that 3D imaging offers novel advantages in the performance of endolaryngeal microsurgical skills to every surgeon. In the near future, the conventional binocular system can be replaced by 3D videolaryngoscopy.

We have an optional procedure of videolaryngoscopy for endolaryngeal microsurgery, which has some advantages, but has a definitive demerit of two dimensional (2D) images as compared to conventional microlaryngoscopy.

In order to overcome the drawback of 2D videolaryngoscopy, we have developed a newly devised 3D videolaryngoscope, and we evaluatedthe usefulness of this device by comparing between our 3D videolaryngoscope and the conventional binocular microscope system.

INTRODUCTION

METHODS AND MATERIALS

1. Votanopoulos T, et al: Impact of Three-Dimensional Vision in Laparoscopic Training. World J Surg (2008) 32:110–118

2. 1: Castelnuovo P, et al: Endoscopic transnasal resection of anterior skull base malignancy with a novel 3D endoscope and neuronavigation. Acta Otorhinolaryngol Ital. 2012 Apr;32(3):189-91.

3. Kari E, et al: Comparison of traditional 2-dimensional endoscopic pituitary surgery with new 3-dimensional endoscopic technology: intraoperative and early postoperative factors. Int Forum Allergy Rhinol. 2012 Jan-Feb;2(1):2-8.

4. Manes Rpet al: Utility of novel 3-dimensional stereoscopic vision system for endoscopic sinonasal and skull-base surgery. Int Forum Allergy Rhinol. 2011 May-Jun;1(3):191-7.

CONCLUSIONS

DISCUSSION

REFERENCES

Table 1. Patients underwent endolaryngeal microsurgery under the 3D videolaryngoscope.

Figure 1. Two types of telescopes (0 & 30 degrees, 5mm in diameter) and a 3D full-hivision camera head with 2 CCDs (Shinkohkohki, Japan) .

ABSTRACT

CONTACT

In five patients with glottic lesion, endolaryngeal microsurgeries were performed successfully under our 3D endoscopic system in a good stereoview (Fig. 4) without any complications. In case #3, we had to combine a binocular microscope with a laser attachment in order to perform laser cordectomy.

Using this 3D system for endolaryngeal microsurgery, we found a several advantages, as compared to a conventional binocular microscope:1. As the surgeon can position very near the patient, fine control of forceps and scissors is easier and more accurate (Fig. 2 vs 5).2. Observation and operation of the subglottis is possible by inserting the scope more deeply. If I insert the scope a little bit deeper into the subglottis, we can observe subglottic region very well, and the subglottic operation becomes easier.3. The same 3D images as those observed by the surgeon can be shared by other doctors and residents, just by putting on polarized glasses.

RESULTS

Figure 3. Point-setter holding the rigid 3D telescope. This instruments can finely manipulate the telescope in the three dimensional direction by turning the small knob (arrow).

case age(y) sex disease

1 64 M keratosis2 7 F papilloma3 61 M glottic cancer T1a4 43 M polyp5 58 F Reinke's edema

Figure 2. Overview of the 3D operating system.The surgeon putting on a polarized glasses can position in the nearer site at ease, which enables finer manipulations.

Figure 5. Set up of the binocular laryngomicroscopy.The surgeon sits very far from the patient, and is compelled to stretch the both hands, resulting unstable manipulation.

Figure 4. Stereovision of the 3D endoscopy (shown in bilateral components). Two channel views are processed in a stereovision, which is monitored by a 3D Hi-Vision display shown in Figure 2.

Left channel viewLeft channel view