{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T23:21:38Z","timestamp":1756682498627,"version":"3.41.2"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T00:00:00Z","timestamp":1620950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold> The widespread application of endoscopic ear surgery (EES), performed through the external auditory canal, has revealed the limitations of the one-handed technique. The RobOtol\u00ae (Collin ORL, Bagneux, France) otological robotic system has been introduced to enable two-handed procedures; however, the thermal properties of dedicated endoscopes, which are usually used in neurosurgery, called \u201cneuro-endoscopes,\u201d have not yet been clarified for the robotic systems. In this study, we aimed to profile the thermal characteristics of two dedicated neuro-endoscopes, as compared to endoscopes used routinely in manual EES, called \u201coto-endoscopes,\u201d and defined by a smaller diameter and shorter length, and to discuss the safe application of robotic assistance in EES.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Two neuro-endoscopes (3.3 mm, 25 cm, 0\u00b0\/30\u00b0) were studied using two routine light sources (LED\/xenon), and two routine oto-endoscopes (3 mm, 14 cm, 0\u00b0\/30\u00b0) were initially measured to provide a comprehensive comparison. Light intensities and temperatures were measured at different power settings. The thermal distributions were measured in an open environment and a human temporal bone model of EES. The cooling measures were also studied.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Light intensity was correlated with stabilized tip temperatures (<jats:italic>P<\/jats:italic> &amp;lt; 0.01, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.8719). Under 100% xenon power, the stabilized temperatures at the tips of 0\u00b0, 30\u00b0 neuro-endoscopes, and 0\u00b0, 30\u00b0 oto-endoscopes were 96.1, 60.1, 67.8, and 56.4\u00b0C, respectively. With 100% LED power, the temperatures decreased by about 10\u00b0C, respectively. For the 0\u00b0 neuro-endoscope, the illuminated area far away 1cm from the tip was below 37\u00b0C when using more than 50% both power, while this distance for 30\u00b0 neuro-endoscope was 0.5 cm. In the EES temporal bone model, the round window area could reach 59.3\u00b0C with the 0\u00b0 neuro-endoscope under 100% xenon power. Suction resulted in a ~1\u20132\u00b0C temperature drop, while a 10 mL saline rinse gave a baseline temperature which lasted for 2.5 min.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Neuro-endoscope causes higher thermal releasing in the surgical cavity of ESS, which should be especially cautious in the robotic system usage. Applying submaximal light intensity, a LED source and intermittent rinsing should be considered for the safer robot-assisted EES using a neuro-endoscope that allows a two-handed surgical procedure.<\/jats:p>","DOI":"10.3389\/fsurg.2021.659688","type":"journal-article","created":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T07:15:21Z","timestamp":1620976521000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Thermal Safety of Endoscopic Usage in Robot-Assisted Middle Ear Surgery: An Experimental Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Jinxi","family":"Pan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haoyue","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Sterkers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huan","family":"Jia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1002\/lary.25048","article-title":"Systematic review of outcomes following observational and operative endoscopic middle ear surgery","volume":"125","author":"Kozin","year":"2015","journal-title":"Laryngoscope."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/j.otc.2016.05.005","article-title":"Incorporating endoscopic ear surgery into your clinical practice","volume":"49","author":"Kozin","year":"2016","journal-title":"Otolaryngol Clin North Am."},{"key":"B3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1017\/S0022215116009828","article-title":"Endoscopic ear surgery: a hot topic?","volume":"131","author":"Mitchell","year":"2017","journal-title":"J Laryngol Otol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"156","DOI":"10.21053\/ceo.2018.00507","article-title":"Comparison of the clinical results of attic cholesteatoma treatment: endoscopic versus microscopic ear surgery","volume":"12","author":"Bae","year":"2019","journal-title":"Clin Exp Otorhinolaryngol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1002\/lary.25760","article-title":"Endoscopic cartilage tympanoplasty: a two-handed technique using an endoscope holder","volume":"126","author":"Khan","year":"2016","journal-title":"Laryngoscope."},{"key":"B6","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s12070-014-0738-y","article-title":"Concept, design and development of innovative endoscope holder system for endoscopic otolaryngological surgeries","volume":"67","author":"Khan","year":"2015","journal-title":"Indian J Otolaryngol Head Neck Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e47","DOI":"10.1097\/SCS.0000000000004022","article-title":"Proposal of a budget-friendly camera holder for endoscopic ear surgery","volume":"29","author":"Ozturan","year":"2018","journal-title":"J Craniofac Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1109\/TBME.2019.2939557","article-title":"Foot-Controlled Robot-Enabled EnDOscope Manipulator (FREEDOM) for sinus surgery: design, control, and evaluation","volume":"67","author":"Zhong","year":"2020","journal-title":"IEEE Trans Biomed Eng."},{"key":"B9","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s00405-020-06070-z","article-title":"Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report","volume":"278","author":"Vittoria","year":"2020","journal-title":"Eur Arch Otorhinolaryngol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.amjoto.2018.07.001","article-title":"Intraoperative thermal safety of endoscopic ear surgery utilizing a holder","volume":"39","author":"Ozturan","year":"2018","journal-title":"Am J Otolaryngol."},{"key":"B11","doi-asserted-by":"crossref","first-page":"p. 850","DOI":"10.1109\/IROS.2010.5650390","article-title":"RobOtol: from design to evaluation of a robot for middle ear surgery","volume-title":"IEEE\/RSJ International Conference on Intelligent Robots and Systems","author":"Miroir","year":"2010"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1002\/lary.23339","article-title":"Heat development at nasal endoscopes' tips: danger of tissue damage? 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