Doctors in Motol Hospital for the first time use a 3D microscope to remove a benign ear tumour

(Prague, 12 February 2021) A 70-years-old patient was operated at the Department of Otorhinolaryngology and Head and Neck Surgery of the First Faculty of Medicine of the Charles University and Motol University Hospital. It was a complicated operation of a vestibular schwannoma in which the doctors for the very first time in the Czech Republic used a digital microscope with 3D imaging.

Vestibular schwannoma is a tumour affecting part of the internal auditory tube from which it spreads into the cerebellopontine angle. In the Czech Republic, only about 100 persons are diagnosed with this tumour each year and several dozen operations are undertaken annually. Although it is a benign tumour, it can threaten the health of patients by developing pressure on the brain stem, where the most important centres of body’s basic functions are located. The seventy years old patient, who suffered from problems with hearing, balance, and tinnitus, was operated by the team of Professor MUDr. Jan Plzák, Ph.D., head of the department.

‘The most common first sign is a unilateral hearing loss, which was also the problem of our patient. Subsequent examinations had shown that she has a nut-sized tumour. Without an operation, the patient would over time find herself at acute risk of loss of life,’ explains Professor Plzák.

Access to this type of tumour is difficult because it leads through an area with crucially important veins and nerves. There are several methods of operating on this kind of tumours. The doctors in Motol opted for trans-labyrinthine access, i.e. through the temporal bone and part of the inner ear.

‘We prefer this method in patients who, due to growth of this tumour, lost their hearing. This access route removes part of the structure of the inner ear but enables us to bypass the structures of brain stem and cerebellum. When the auditory nerve is preserved, it is also a good starting point for possible cochlear implantation,’ sums up Professor Plzák.

In 3D for everyone in the operating theatre

The Department of Otorhinolaryngology and Surgery of Head and Neck of the First Faculty of Medicine of the Charles University and University Hospital Motol is so far the only ORL department in the Czech Republic that has at its disposal a digital microscope with 4D imaging. It is regularly used in ear surgery, surgery of the skull base, and for oncological surgery in the area of head and neck, especially the oropharynx. This is, however, the first time it was used during an operation of a vestibular schwannoma.

This technology has a number of advantages. Unlike a classical microscope, the surgeon does not view the place he operates on through an eyepiece but on a monitor in 3D projection using 3D goggles.

‘The possibility of separating the operating field from the operator is highly desirable especially during the current Covid epidemic, when we have to follow the strictest hygienic measures,’ emphasises the head of the clinic, noting that for the course of the surgery as such, the imaging qualities of instruments are of key importance. ‘A digital microscope provides excellent light and image of the entire operating field, which can be followed not only by the surgeon but also the assistant, theatre nurse, anaesthesiology team, and interns, who all see the same thing,’ adds Professor Plzák.

Doc. MUDr. Jan Bouček, Ph.D., deputy head for science and research who focuses on surgery of head and neck, explains that especially in the area of ORL, automatic fixation of the operating field is tremendously important. ‘When the angle at which one operates or angle of view should move, we now do not need to move the patient or the microscope. Instead, we can use an automatised mechanism to rotate the microscope head around the point we need to focus on,’ adds doc. Bouček.

Because the department is part of a university hospital, medics also had a chance to see the technique. ‘The advantage of this is both in our medical students being in touch with the most up-to-date operating technologies and the fact that they could see exactly what the operating surgeon is going throughout the surgery, which is immensely valuable for teaching as such,’ notes Professor Martin Vokurka, CSc., Dean of the First Faculty of Medicine, regarding the use of innovative technology.