Video-Assisted Cleft Palate Surgery: Preclinical Comparison Between Endoscope- and Exoscope-Based Approaches

Objective: Using both endoscope and exoscope in cleft soft palate surgery is not widespread, despite the potential advantages related to view magnification, ergonomic posture of the surgeon, and involvement of the surgical team. Design: The aim of the current study is to compare endoscopic (Olympus Visera((C))) and exoscopic (Karl-Storz Vitom((C))) assistance in cleft soft palate surgery in a preclinical cadaver setting. Setting: A formalin fixed specimen was dissected to mimic the anatomical conditions of a cleft soft palate. Participants: Ten young surgeons with limited experience in transoral surgery were involved in the exercitation on the specimen. Interventions: The exercitation consisted of 4 tasks: (1) device setting; (2) identification of muscle plane; (3) muscle suturing; (4) oral mucosa suturing. Main outcomes: Participants were timed while performing each task both with exoscope and endoscope and asked to fill in 2 questionnaires related to the visual systems used (NASA Task Load System TLS and VAS 1 -10). Results: All surgeons completed the 4 tasks with both the endoscope and exoscope. The execution times were similar except for faster setting of the exoscope. Participants felt that completing surgical exercises using the exoscope required less physical, intellectual, and temporal efforts compared to the endoscope. The exoscope was also more appreciated for its handling, 3D visualization, and limited encumbrance. Conclusions: Exoscope scored better both at NASA TLS and VAS 1 -10 and required a faster setting than endoscope. Further clinical in-vivo studies are required to explore the advantages of these devices in cleft palate repair.