Surgical Atlas of Transcanal Endoscopic Ear Surgery A Step by Step Guide
Surgical Atlas of Transcanal Endoscopic Ear Surgery A Step by Step Guide
Authors
Arindam Das
MS (ENT)
Consultant Otologist and Endoscopic Ear Surgeon Assistant Professor Institute of Otorhinolaryngology & Head and Neck Surgery (IORL & HNS) Institute of Postgraduate Medical Education and Research (IPGMER) and SSKM Hospital Kolkata, West Bengal, India
Sandipta Mitra
MBBS MS MRCS (London) DNB
Senior Resident (Academic) All India Institute of Medical Sciences, New Delhi Former Senior Resident Institute of Otorhinolaryngology & Head and Neck Surgery (IORL & HNS) Institute of Postgraduate Medical Education and Research (IPGMER) and SSKM Hospital Kolkata, West Bengal, India
Sayan Hazra
MBBS MS-ENT (Gold Medal) DNB
Consultant Otologist and Endoscopic Ear Surgeon Senior Resident (ENT) Institute of Otorhinolaryngology & Head and Neck Surgery (IORL & HNS) Institute of Postgraduate Medical Education and Research (IPGMER) and SSKM Hospital Kolkata, West Bengal, India
Forewords
Mohamed MK Badr-El-Dine
Nirmal Patel
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Surgical Atlas of Transcanal Endoscopic Ear Surgery: A Step by Step Guide
First Edition: 2023
9789354658884
Printed at:
Our teacher
Prof. (Dr) Arunabha Sengupta
who inspires us to
believe that everything is possible and leaves no stone
unturned in making anything possible.
Over the last two decades, it was evident that endoscopic ear surgery would dramatically change our techniques in performing otologic surgery. The sheer introduction of transcanal endoscopic procedures rediscovered the complex anatomy of the ear and enabled better visualization of all hidden recesses otherwise not visible by microscopic techniques. Progress in endoscopic instrumentations, along with the experience gained over the years extended our indications for endoscopic ear surgery to cover most of the otologic procedures. Based on the vast technical progress in the field of otology in the past few decades, the rational to accept trends towards less-invasive procedures and embrace a better quality of life will proceed. In all likelihood, the concept of functional endoscopic ear surgery will prevail in the near future.
I am very appreciative to Dr Arindam Das and his team, for asking me to write a foreword for this comprehensive and fascinating book on endoscopic ear surgery titled Surgical Atlas of Transcanal Endoscopic Ear Surgery: A Step by Step Guide. I was very impressed by the idea and content of this atlas discussing the importance of endoscopic ear surgery and describing in an easy instructive way the different surgical procedures used.
The book not only reflects an impressive amount of work, but also great teaching capabilities. The elaborate illustrations facilitated the understanding of surgical anatomy in a straightforward manner. The surgical pearls presented reflect deep experience and provide practical tips important for practitioners in the field of otology and endoscopic ear surgery.
I am certain that this book will be used as a reference to both junior ENT surgeons as well as senior otologists. Residents using this book will have a useful practical guide before and after each surgery during their training program.
My sincere congratulations and deep appreciation goes to Dr Arindam Das and his team for this excellent contribution to the literature that will promote endoscopic ear surgery not only in India but all over the world.
Mohamed MK Badr-El-Dine MD PhD
Professor (Otolaryngology)
Faculty of Medicine
Alexandria University
Alexandria, Egypt
Consultant (Otology, Neurotology and
Skull Base Surgery)
Sultan Qaboos University Hospital
Muscat, Oman
President
International Working Group on
Endoscopic Ear Surgery (IWGEES)
Foreword
Endoscopic ear surgery has gone from an esoteric discipline to mainstream surgery in the last 10 years. Following the same historical path as endoscopic sinus surgery, the method was initially scorned as dangerous and illogical single-handed application of something which could easily be performed with two hands. There were doubters but now, all our trainees and recent graduates will agree that the endoscope delivers superior views and surgical techniques to the middle ear when compared to the microscope. By bringing the surgeons eye into the ear, contextual anatomy is better understood and surgical education is enhanced as the teacher sees the same as the learner.
Indeed, now we find that the majority of tympanoplasties and middle ear cholesteatoma can be performed transcanal saving the incisions and destruction of normal tissue to access the pathological site. This has become especially noticeable in my own pediatric practice where now most children are saved an incision for these surgeries. A huge relief for parents. Robust evidence now points to better surgical education, better quality of life outcomes and similar if not superior results with tympanoplasty and middle ear cholesteatoma surgery when comparing the endoscope to the microscope.
As with all adoption of newer surgical techniques clear concise visual explanations serve to enhance the understanding of the learner. Drs Arindam Das, Sandipta Mitra and Sayan Hazra have created a beautiful surgical atlas of the method. Beginning with the anatomy, OR setup and then progressing through basic and more complex methods the book walks the readers through the technique with high quality photography and illustrations to enhance the text. The readers will gain an in-depth understanding of all the endoscopic steps for all major pathologies of the middle ear.
This book will be an important addition to the library of all trainees and junior consultants. All senior microscopic surgeons looking to introduce the technique of endoscopic ear surgery to their practice will gain benefit from the detailed descriptions and pearls presented in the book. I congratulate Arindam Das, Sandipta Mitra and Sayan Hazra on this major effort!
Nirmal Patel MBBS (Hons) FRACS (OHNS) MS (Research UNSW)
General Secretary
International Working Group on Endoscopic Ear Surgery
Clinical Professor (Surgery)
Macquarie University, Sydney
Clinical Associate Professor (Surgery)
University of Sydney
Head (Surgical Training)
Department of Otolaryngology: Head and Neck Surgery
Royal North Shore Hospital
Sydney, Australia
Fellowship Director: SEES Group
Preface
Why is endoscopic ear surgery gaining enormous popularity amongst otologists in the last few years? We believe it is a very relevant question in recent times. At present, endoscopic ear surgery can address majority of the otological procedures that were done in the conventional manner, since inception. Interestingly, conventional microscopic ear surgical techniques got a whole new perspective after introduction of endoscopy in otology. Pathophysiology of a disease rarely changes, but we, as surgeons, are constantly evolving our surgical approaches in order to improve the result of the surgery. Endoscopic ear surgery provides a panoramic view of the surgical field and gives a close and magnified view of the vital structures. Once exposed to such a perspective, it is difficult for otologists and endoscopic ear surgeons alike, not to get addicted to this brilliant visualization. But before embarking upon this surgery, it is imperative to know the endoscopic middle ear anatomy thoroughly and understand the new principles of endoscopic ear surgery. At this opportunity, we would like to introduce our atlas which is aimed to give the readers a virtual tour into the realm of endoscopic ear surgery. It is a manual of this newly evolving surgical technique, meticulously described, to make it possible to perform, even for beginners.
In the era of minimally invasive surgery, it is a treat for every otologist to learn this highly specialized skill. We have observed that the newer generation of otologist, especially the residents, are keen to learn endoscopic techniques of ear surgery. Every aspiring surgeon searches for a surgical manual, which shall give them the insight into the surgical technique by narrating every minute detail of the surgery, make them aware of the difficulties of the technique and guide them to overcome them. This was exactly the idea behind this endeavor.
The atlas covers minor OPD procedures, such as myringotomy and grommet insertion to extremely complicated endoscopic surgery like facial nerve decompression. Endoscopic ear anatomy includes the fine micro-details of the tympanic cavity. Retrotympanum, epitympanum and protympanum have been vividly described in the atlas to make the young aspiring surgeons familiar with these new anatomical landmarks. We have tried to describe the anatomy of chorda tympani nerve in unique way, adapting to the endoscopic perspective. Starting from operation theater setup to special instruments and their use have been documented here. We have recorded all surgeries in best quality in high definition and provided crisp and clear surgical pictures, as far as possible. To make learning lucid and interesting we have included digital art diagrams to describe the anatomical landmarks and the latest anatomical concepts. “Surgical importance”, “Pearls” and “Tips” have also been included to make it more relevant for practicing otologic surgeons. We have included new concepts and grading system which we have formulated, that have been published in peer reviewed, PubMed indexed, world-renowned journals. As per authors’ knowledge, endoscopic facial nerve decompression has never been documented in such extensive manner.
A few lessons from our journey into the world of endoscopic ear surgery: At the start of endoscopic ear surgery, owing to its intricacies, one will encounter many difficulties, often leading to disappointment. But one needs to continue the surgical endeavor slowly and patiently. With the correct approach and practice, one will surely overcome the obstacles eventually. Single handed surgery is the most challenging factor of endoscopic ear surgery. But the trick is to learn the alternative techniques to overcome its hindrances. We believe it is a mere thought-block that keeps a surgeon from achieving his true potential. Bleeding is another limitation that needs to be controlled using proper measures, to improve visualization of the surgical field. Every such minute detail of endoscopic surgical technique and its complications have been dealt with in this atlas.
We should always remember that there is no tussle between endoscopic and microscopic ear surgery. Both are pillars in the foundation of otologic surgery, having their own advantages and disadvantages. Most importantly, every endoscopic ear surgeon should understand the limitations and contraindications of this new technique.
Arindam Das
Sandipta Mitra
Sayan Hazra
Acknowledgments
It gives us immense pleasure in introducing the first edition of our book. We would like to express our earnest indebtedness to eminent professors and teachers for their relentless support and invaluable suggestions. We would like to specially thank Drs Mohamed MK Badr-El-Dine and Nirmal Patel for penning the valuable forewords of our book.
We owe a debt of gratitude towards the Institute of Otorhinolaryngology & Head and Neck Surgery (IORL & HNS) for providing us with state-of-the-art facilities, including the best endoscopes, three-chip camera, facial nerve monitor, CO2 laser and skeeter drill. We express our heartfelt gratitude to our teacher, Professor (Dr) Arunabha Sengupta for his immense support and guidance behind this book. We are thankful to Professor (Dr) Debasis Barman (Director and Head, IORL & HNS), Professor (Dr) Manimoy Bandhopadhyay (Director, IPGMER), and Professor (Dr) Piyush Kumar Roy (MSVP, IPGMER) for their unstinting backing.
Dr RN Patil, pioneer of endoscopic ear surgery in India has been instrumental in igniting the passion in us to pursue the art. Concepts taught by Professor (Dr) H Vijeyandra and Professor (Dr) KP Morwani on basics of otology have been the building blocks of our otology journey.
Endoscopic ear surgery is incomplete without the mention of Drs Joao Flavio, Muaaz Tarabichi, Livio Presutti and Daniele Marchioni, whose remarkable work in the field of endoscopic ear surgery has enlightened one and all.
We are overwhelmed to be associated with doyens in the field of otorhinolaryngology in India, Professor (Dr) Dulal Kumar Basu and Professor (Dr) Amitabha Roychoudhury, who have always guided and supported us.
We truly appreciate the valuable inputs given by our teachers Professor (Dr) Sumanta Kumar Dutta, Professor (Dr) Bijan Basak, Dr Alok Ranjan Mondal, Dr Sourav Dutta and Dr Kaustuv Das Biswas. We are thankful to our anesthesiologist colleagues, residents and staffs of Institute of Otorhinolaryngology, SSKM Hospital. We thank the Senior Residents of the Institute, Drs Pranay Agarwal, Ankit Choudhary, Soutrik Kumar, Mridul Janweja, Aryabrata Dubey and Sauravmoy Banerjee, who have helped us in various stages of preparation of this book.
A special mention goes to Drs Monish Bose, Sanjay Gupta, Deepjoy Basu and Lopamudra (Misra) Chakraborty, who have supported us in every possible way in performing and documentation of surgeries on regular basis.
We are extremely thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra (Senior Director – Professional Publishing, Marketing and Business Development), Ms Pooja Bhandari (Production Head), and Dr Rajul Jain (Senior Development Editor) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for making all efforts in editing the manuscript to finally bring the printed version to our readers.
It is impossible to thank our parents and family enough, who stood by us during the entire process.
Last but not the least, we are forever indebted to our patients who trusted us to perform the surgeries and document them for publication.
We hope the readers enjoy the book as much as we enjoyed writing it.