Indications, Functional, and Surgical Outcomes of High-Definition 3-Dimensional Exoscopic Microlaryngeal Surgery: A Systematic Review.

[BACKGROUND] High-definition 3-dimensional (HD-3D) exoscope is an emerging surgical tool in laryngology competing with classical operative microscopes. The aim of this systematic review was to investigate the current literature about indications, functional, and surgical outcomes of laryngeal surgery performed with the HD-3D exoscope.

[METHODS] Two independent investigators conducted a systematic search of the literature using PubMed, Embase, and Cochrane Library databases for studies investigating indications, surgical, functional, and ergonomic/teaching outcomes of laryngeal microsurgery with HD-3D exoscope. The preferred reporting items for systematic reviews and meta-analyses statements were followed. Methodological index for non-randomized studies was used for bias analysis.

[RESULTS] Of the 71 identified papers, nine studies met the inclusion criteria (290 patients). The primary indications of HD-3D exoscope laryngeal surgery matched with those of laryngeal microsurgery procedures, including benign vocal fold lesions (n = 119, 41.2%), glottic insufficiency (n = 37, 12.5%), premalignant (n = 18, 6.1%), and malignant (n = 115, 38.9%) lesions. Surgical (operative time, complication rate, and hospital stay), oncological (margin status), and functional (voice and swallowing quality evaluations) outcomes were overall similar between patients operated with HD-3D exoscope versus operative microscope. The benefits of HD-3D exoscopes primarily consisted of improved surgeon ergonomics and enhanced teaching process. The heterogeneity across studies was high, with no controlled randomized study comparing the traditional microscope versus the HD-3D exoscope for surgical and functional outcomes.

[CONCLUSION] The preliminary studies did not demonstrate superiority of 3D-HD exoscope over traditional microscope for laryngeal microsurgery in terms of surgical and voice quality outcomes. Exoscope systems could be useful for sharing information on surgical procedures and anatomy for trainees, suggesting an educational role, but future large cohort studies are needed to demonstrate that in laryngology.