Cochlear implant surgery using the 4 K-three-dimensional exoscope ORBEYE: a comparative study with conventional operative microscope.

purposeTo evaluate the feasibility of the 4 K-three-dimensional (3D) exoscope ORBEYE (ExS) in cochlear implant (CI) surgery and compare its advantages and limitations with the conventional operating microscope (OM).

methodsWe retrospectively analyzed 77 consecutive CI surgeries performed between January 2019 and December 2023 (42 with ExS and 35 with OM). Surgical outcomes, complications, and hearing results were compared between the groups. Eight otologists completed a questionnaire comparing technical performance, operative performance, team interaction, and procedure-specific performance of both visualization systems.

resultsAll ExS group surgeries were successfully completed using the ExS alone. The operating time was significantly longer in the ExS group than in the OM group (162 vs. 130 min, p = 0.0051), and the resident participation rate in mastoidectomy procedures was higher (28.6% vs. 8.6%, p = 0.0417). When excluding cases where residents performed mastoidectomy, the operating time did not markedly differ between the groups (152 vs. 130.5 min, p = 0.1532). The hospital stay and complication rates were also comparable. Both systems achieved similar hearing improvements. The questionnaire results revealed a clear preference for ExS across all evaluation domains except for natural stereoscopic perception. ExS demonstrated advantages in implant bed creation, cochleostomy, and electrode insertion.

conclusionsThe 4 K-3D ExS ORBEYE demonstrated comparable surgical outcomes to those of conventional OM in CI surgery. The longer operative time in the ExS group appeared to reflect educational benefits rather than technical limitations. ExS offers a viable alternative to OM for CI surgery, with advantages across multiple performance domains, including team interaction and surgical education.