Otology Japan
Online ISSN : 1884-1457
Print ISSN : 0917-2025
ISSN-L : 0917-2025
内視鏡を用いた耳科手術
手術用顕微鏡と内視鏡の併用
枝松 秀雄井上 さと美江口 智徳渡辺 建介
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ジャーナル フリー

2000 年 10 巻 3 号 p. 164-168

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Otosurgery have been developed with an operative microscope which can give a totalview of the middle ear cavity.In the middle ear, however, there is the retrotympanic region where microscopic observation is difficult because of anatomical feature.This region includes the important structures, such as stapes, stapedial muscle, tympanic part of facial nerve, pyramidal eminence, tympanic sinus, and round window.It is very dangerous to perform otosurgery without adequate observation of these structures.
In order to perform a surgery safely with a full operative view, we introduced a rigid endoscope 4mm in diameter and 15cm in length with 0° and 30° angles of vision.The endoscopic-aided operation was performed in 53 ears for the last two years.With general anaesthesia, the endoscope was introduced into the tympanic cavity through a perforated or elevated tympanic membrane.
The endoscopic observation was monitored on TV screen and recorded in video.The endoscopic imagings were much more clean and widely expanded than those with a microscope with 25cm focus lens, because the endoscope can be introduced closely to a target within 5mm.They could show the detailed and bright views of microscopically invisible structure.
The disadvantages of the endoscope are that a surgeon has to hold the endoscope with his or her left hand and handle forceps or suction tube with the right, and to handle endoscope and surgical tools together in the narrow external canal.In 3 ears, the 4mm-diameter endoscope was difficult to insert in the canal and 3mm endoscope was substituted.Therefore, endoscopic guided ear operation needs some extent of expertise.
The endoscope, however, was very useful in otosurgery, especially to find residual cholesteatoma in tympanic sinus, under the ossicle or to avoid an injury of the facial nerve in stapedectomy.

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