<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-7986</journal-id>
<journal-title><![CDATA[Revista ORL]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. ORL]]></abbrev-journal-title>
<issn>2444-7986</issn>
<publisher>
<publisher-name><![CDATA[Ediciones Universidad de Salamanca]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-79862025000400215</article-id>
<article-id pub-id-type="doi">10.14201/orl.34201</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Exoscopio 3D en Cirugía Otológica y de Base de Cráneo Lateral. Revisión Sistemática]]></article-title>
<article-title xml:lang=""><![CDATA[3D exoscope in otology and lateral skull base surgery. Systematic review]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[QUER-CASTELLS]]></surname>
<given-names><![CDATA[Mireia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[REMACHA-SARDÀ]]></surname>
<given-names><![CDATA[Joan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[PEDEMONTE-SARRIAS]]></surname>
<given-names><![CDATA[Gabriel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[CODINA-AROCA]]></surname>
<given-names><![CDATA[Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[PIÑEIRO-AGUÍN]]></surname>
<given-names><![CDATA[Zenaida]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[LARROSA-DÍAZ]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Servicio de Otorrinolaringología Hospital del Mar, Barcelona ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Servicio de Otorrinolaringología Hospital Clínic de Barcelona ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Facultad de Medicina Universitat Pompeu Fabra ]]></institution>
<addr-line><![CDATA[ Barcelona]]></addr-line>
<country>España</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Departamento de Especialidades Médico-Quirúrgicas Facultad de Medicina Universitat de Barcelona]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>España</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>16</volume>
<numero>4</numero>
<fpage>215</fpage>
<lpage>225</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S2444-79862025000400215&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S2444-79862025000400215&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S2444-79862025000400215&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción y objetivo: El exoscopio 3D se ha introducido en otología y cirugía de base de cráneo como alternativa al microscopio quirúrgico, con potenciales beneficios en visualización, ergonomía y docencia. Sin embargo, la evidencia disponible continúa siendo heterogénea. El objetivo de esta revisión sistemática es sintetizar la literatura publicada sobre el uso del exoscopio en cirugía otológica y de base de cráneo lateral, con especial énfasis en su comparación con el microscopio óptico.  Método: Se realizó una revisión sistemática siguiendo la declaración PRISMA 2020. Se consultaron las bases de datos PubMed y Cochrane hasta el 25 de agosto de 2025, utilizando términos MeSH y palabras clave relacionados con ear surgery, otologic surgical procedures y exoscope. Se incluyeron estudios originales en inglés o español realizados en humanos, y se excluyeron reportes de un caso, estudios en cadáveres o simulación, editoriales y estudios no originales.  Resultados: De 146 registros identificados, se incluyeron 20 estudios (9 cohortes retrospectivas, 4 cohortes prospectivas y 7 series de casos), con un total de 729 pacientes: 490 operados con exoscopio y 239 con microscopio. Los procedimientos más frecuentes con exoscopio fueron implantes cocleares (42 %), cirugía de oído medio crónico (37,6 %), estapedotomías (12,7 %) y cirugía de base lateral del cráneo (7 %). Las complicaciones fueron similares entre exoscopio (3,7 %) y microscopio (5,6 %), sin diferencias significativas. Seis estudios compararon resultados auditivos sin encontrar diferencias. En ergonomía, el exoscopio mejoró de forma significativa la puntuación RULA (reducción media del 63,6 %; p &lt; 0,001) y redujo la incidencia de dolor cervical. En calidad de imagen, se describió mayor luminosidad y campo visual más amplio en fases iniciales de implantes coclear y estapedotomía, aunque el microscopio resultó superior en campos quirúrgicos estrechos y de gran aumento.  Discusión: La evidencia disponible sugiere que el exoscopio ofrece resultados quirúrgicos comparables al microscopio, con ventajas en ergonomía y docencia. La calidad de imagen se percibe superior en implantes cocleares y en fases iniciales de estapedotomía, aunque el microscopio sigue siendo más eficaz en campos estrechos y de gran aumento. Su principal aporte es la mejora ergonómica, con reducción objetiva de la carga musculoesquelética y menor dolor cervical. Limitaciones descritas incluyen menor nitidez en profundidad con pérdida de definición a grandes aumentos y un elevado coste. La curva de aprendizaje es corta, con progresiva reducción del tiempo quirúrgico.  Conclusiones: El exoscopio 3D es un sistema de visualización seguro y eficaz en cirugía otológica y de base lateral de cráneo. Ofrece ventajas en ergonomía y visualización en campos abiertos, aunque no sustituye al microscopio. Además, puede representar una herramienta docente de gran utilidad.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary:  Introduction and objective: The 3D exoscope has been introduced in otology and lateral skull base surgery as an alternative to the operating microscope, with potential benefits in ergonomics, teaching, and visualization. However, the available evidence remains heterogeneous. The objective of this systematic review is to synthesize the published literature on the use of the exoscope in otologic and lateral skull base surgery, with particular emphasis on comparisons with the optical microscope.  Method: A systematic review was conducted according to the PRISMA 2020 statement. PubMed and Cochrane databases were searched up to August 25, 2025, using MeSH terms and keywords related to ear surgery, otologic surgical procedures, and exoscope. Original studies in English or Spanish involving humans were included, while case reports, cadaveric or simulation studies, editorials, and non-original articles were excluded.  Results: Of 146 records identified, 20 studies were included (9 retrospective cohorts, 4 prospective cohorts, and 7 case series), with a total of 729 patients: 490 operated with the exoscope and 239 with the microscope. The most frequent exoscope procedures were cochlear implants (42 %), chronic ear surgery (37.6 %), stapedotomies (12.7 %), and lateral skull base surgery (7 %). Complication rates were similar between exoscope (3.7 %) and microscope (5.6 %) groups, with no significant differences. Six studies compared audiological outcomes, finding no differences. Ergonomic assessment showed a significant improvement in RULA scores (mean reduction 63.6 %; p &lt; 0.001) and decreased cervical pain with the exoscope. Image quality was reported as superior in early phases of cochlear implantation and stapedotomy, while the microscope performed better in narrow and high-magnification fields.  Discussion: Current evidence suggests that the exoscope provides surgical outcomes comparable to the microscope, with consistent advantages in ergonomics and teaching. Image quality is often perceived as superior in cochlear implantation and initial stapedotomy phases, although the microscope remains superior in deep and narrow fields. Reported limitations include reduced sharpness at high magnification, decreased performance in depth, and high cost. The learning curve is short, with progressive reduction in operative times.  Conclusions: The 3D exoscope is a feasible, safe, and effective tool in otologic and lateral skull base surgery. It offers ergonomic and visualization advantages in open surgical fields, though it does not fully replace the microscope. Additionally, it may represent a valuable teaching instrument.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[exoscopio]]></kwd>
<kwd lng="es"><![CDATA[otología]]></kwd>
<kwd lng="es"><![CDATA[base de cráneo lateral]]></kwd>
<kwd lng="es"><![CDATA[microscopio óptico]]></kwd>
<kwd lng="es"><![CDATA[ergonomía]]></kwd>
<kwd lng="es"><![CDATA[cirugía del oído]]></kwd>
<kwd lng="en"><![CDATA[exoscope]]></kwd>
<kwd lng="en"><![CDATA[otology]]></kwd>
<kwd lng="en"><![CDATA[lateral skull base]]></kwd>
<kwd lng="en"><![CDATA[operating microscope]]></kwd>
<kwd lng="en"><![CDATA[ergonomics]]></kwd>
<kwd lng="en"><![CDATA[ear surgery]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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