Does the visual system affect the learning curve of the Otosurgeon? A cadaveric study comparing microscopy vs exoscopy

Purpose: Optical magnification is crucial in ear surgery, ensuring the precise identification of anatomical structures. Traditionally, microscopes have been the standard due to their magnification and stereoscopic capabilities. However, the introduction of exoscopes has introduced new possibilities, particularly in ergonomics, teaching, collaboration, and surgical training. This cadaveric study aimed to evaluate the feasibility, effectiveness, and trainee performance when using the exoscope in ear dissection and to compare it with the traditional microscope. Methods: This study involved 10 non-expert medical trainees who undertook a series of surgical tasks on cadaveric specimens using both the microscope and exoscope. The tasks included different surgical approach simulations and exercises. NASA Task Load Index and a Visual Analog Scale questionnaires were administered to assess participants' subjective experiences with each instrument. Results: All participants successfully completed the assigned tasks with both the microscope and exoscope. While there were no significant differences in the timing of surgical steps between the two instruments, participants perceived the microscope as less physically demanding and temporally taxing, while the exoscope excelled in structural identification and offered benefits for teaching and collaboration. Conclusions: The choice between microscope and exoscope should be guided by the specific surgical demands, educational context, and preferences of the team. While the microscope excels in flexibility, the exoscope provides advantages in structural identification and collaborative learning, making it a valuable tool in ear surgery. This study contributes valuable insights for otological surgeons and educators to optimize surgical outcomes and learning experiences of trainees.