Exoscope and Microscope Show Equivalence in Operative Times and Outcomes for Microlaryngeal Surgery

Objectives: Newer optical systems such as 3D exoscopes are now being utilized for magnification and visualization in surgical fields like neurosurgery and otolaryngology. We seek to compare operative times and clinical outcomes between the operating exoscope (OE) and traditional operating microscopes (OM) for microlaryngeal surgery (MLS). Methods: We conducted a retrospective, single-center review of patients who underwent MLS from 2019 to 2024 using the OE or OM, comparing operative times and voice outcome measures including patient subjective vocal quality, OMNI vocal effort, and GRBAS scales. Results: Eighty-four (45 OE and 39 OM) patients underwent MLS for primarily phonotraumatic vocal fold lesions. There were no statistically significant differences in operative time (in minutes) between OE versus OM cohorts: setup time (22 vs. 21, p value = 0.54), procedure length (46 vs. 49, p = 0.45), and total patient time in OR (83 vs. 86, p = 0.57). There were no significant differences in pre-operative voice assessments between the OE and OM cohorts. There were also no significant differences in post-operative (4–6 weeks) subjective vocal quality (7.8 vs. 7.5, p = 0.57), OMNI vocal effort (3.1 vs. 3.9, p = 0.28), or GRBAS scale (G: 0.80 vs. 0.85, p = 0.74; R: 0.82 vs. 0.72, p = 0.46; B: 0.26 vs. 0.41, p = 0.24; A: 0.18 vs. 0.10, p = 0.36; S: 0.56 vs. 0.51, p = 0.75). There were no serious intraoperative or postoperative complications in either cohort. Conclusion: This is the first study directly comparing the OE to the OM in MLS. Our findings demonstrate non-inferiority of the OE compared to the OM for operative times and voice outcomes. Level of Evidence: 3.