Advantages and Limitations of Operating Microscope in Ear Surgery

 

ENT surgery often utilizes an operating microscope to enhance precision and visualization during procedures. The use of an operating microscope is a common practice in both routine and complex ENT surgeries, including ear surgeries such as Myringoplasty, Tympanoplasty, Mastoidectomy, and Myringotomy with tube placement etc. 
The reason for the use of a Microscope- middle ear structures are very small and difficult to visualize with the naked eye. That is why a microscope is required so that a magnified view of the operated object can be obtained. This helps in the accuracy of the surgery and also prevents complications.

The advantages of an Operating Microscope are

1. View is magnified with good lighting and vision

2. The operators’ hands are free - both the hands are free to perform the surgery.

The problems with an Operating Microscope are

1. The microscope can see only in a straight line- along the sight of vision. In this situation some important structures/ disease elements remain hidden from view.

2. Because of the fixed focal length of the Microscope it has to be placed at that distance - it cannot be brought closer to the object.

There has been a recent change or innovation in middle ear surgeries where we have started using a rigid telescope - an endoscope- to perform these surgeries.

The advantage of an Endoscopic ear surgery is that since we can use angled endoscopes, and take them close to the operating site we can see hidden areas.

The disadvantage of an Endoscopic ear surgery is that it is usually a single hand procedure - since one hand is used to hold the endoscope. There has been a recent innovation in this - some surgeons have started using endoscope holders to free up both their hands. In the final analysis - each have their advantages and disadvantages- it depends upon the surgeon's training and experience as well as availability of equipment. The final outcome would probably be a hybrid approach where each method is used to derive the most benefit during an ear surgery.

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