Enhanced visualization of the surgical field in pediatric direct laryngoscopy using a three-dimensional endoscopic system

Oshri Wasserzug, Gad Fishman, Anat Wengier, Yael Oestreicher-Kedem, Ophir Handzel, Dan M. Fliss, Nevo Margalit, Ahmad Safadi, Ari DeRowe

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Direct laryngoscopy and rigid bronchoscopy are currently performed using 2-dimensional endoscopic systems. Our objective was to determine whether a 3-dimensional endoscopic system can enhance visualization of the surgical field in pediatric direct laryngoscopy and rigid bronchoscopy. Methods: A prospective cohort study was conducted. Thirty three children who underwent direct laryngoscopies in a tertiary referral children's hospital were enrolled. Direct laryngoscopy was performed using both 2- and 3-dimensional endoscopic systems, after which the surgeons scored the quality of the images obtained with each system on a scale from 1 (low) to 5 (high). Comparison of the scores obtained with the 2 endoscopic systems was performed. Results: The 33 study children (mean age 2.3 years, M:F ratio 1:1.6) underwent 47 direct laryngoscopies. The mean score for visualization of the glottis was 4.8 for the three-dimensional system compared to 4.0 for the two-dimensional system (P =.025), 4.7 vs. 3.8, respectively, (P =.019) for the subglottis, and 4.6 vs. 3.9, respectively (P =.031) for visualization of the proximal trachea. The mean score for visualization of the distal trachea was 3.0 vs. 3.7, respectively (P =.020). In a child with recurrent type 3 laryngotracheal cleft a residual tracheo-esophageal fistula could not be detected using the 2D system, but was immediately detected using the 3D system. Conclusions: Visualization of the glottis, subglottis and proximal trachea during direct laryngoscopy using a 3-dimensional endoscopic system was rated by the surgeons as being superior to the conventional 2-dimensional technique. Further outcome studies that will demonstrate the clinical advantage of the 3D technology are highly required. Level of evidence: 2b.

Original languageEnglish
Pages (from-to)628-630
Number of pages3
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume39
Issue number5
DOIs
StatePublished - 1 Sep 2018
Externally publishedYes

Keywords

  • Direct laryngoscopy
  • Image quality
  • Scoring
  • Subglottic stenosis
  • Three dimensional endoscopic system

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