A high-definition 3-dimensional exoscope with the ARTip cruise system as an effective new tool for phonosurgery : a preliminary report

The aim of phonosurgery is to improve voice quality and efficiency by performing precise, minimally invasive, conservative treatment. Magnified visualization of the vocal folds is mandatory to achieve optimal results; operative microscopy has been utilized so far to perform phonosurgery. In recent decades, the use of an exoscope (extracorporeal telescope) has been proposed in several fields of surgery that necessitate magnification. Further technological advancements have enabled 3-dimensional (3D) technology to be added to existing exoscopes. Recently, a motorized holding arm (the ARTip Cruise System) was developed to allow smooth precise positioning of the 3D Vitom exoscope (Karl Storz, Tuttlingen, Germany) by the surgeon without need for assistance. To evaluate the feasibility of phonosurgery by means of this innovative system, we utilized it for six consecutive procedures for benign laryngeal pathologies, including two vocal fold polyps, two cysts, one Reinke's edema and one unilateral vocal fold paralysis treated by fat augmentation. All procedures were performed without any technical difficulty and with excellent results at follow-up, as demonstrated by GRBAS, VHI-10 and maximal phonation time evaluations. Main advantages of this technique were the enhanced depth of field and high definition of anatomical details. Communication with the operating room team was facilitated by the shared view of the same images on screen; furthermore, the surgeon could perform the procedures visualizing the surgical site without need to position the eyes on the microscope eyepieces and so being able to wear full face protection, which was of paramount importance in the era of the COVID-19 pandemic. In conclusion, the 4K 3D exoscope system with the ARTip Cruise System represents a promising innovation in the field of voice surgery to allow highly precise procedures optimizing safety and co-operation with the operating room team.