Background
At the end of 2019, an outbreak of a respiratory disease called “novel
coronavirus disease 2019” (COVID-19) started in Wuhan (China) and has
spread worldwide, reaching a pandemic proportion since
11th March. To date (24th April
2020), the responsible pathogen, the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), has infected 2’626’321 people all over the
world, causing 181 938 confirmed deaths. The most affected countries are
U.S.A., Italy and Spain, with 42’311, 25’549, and 22’157deaths,
respectively, according to W.H.O. data. The unpredictable speed of
diffusion, notwithstanding a low direct mortality rate, brought to a
severe intensive care units overcrowding and seriously jeopardize
health-services, particularly in Italy.
Indeed, the risk of contagion is higher in the hospital environment than
in the community. A supposed hospital-related transmission has been
estimated to occur in more than 40% of cases.1 Among
healthcare workers, anesthesiologists, otorhinolaryngologists and head
and neck surgeons seem to be the most prone to direct
exposure.2 In fact, being the SARS-CoV-2 primarily
transmitted by respiratory droplets or infected secretions, the
abovementioned specialists daily incur high-risk clinical maneuvers and
surgical procedures, such as intubation, nasal endoscopy, flexible fiber
endoscopy of the upper aerodigestive tract, and oral or oropharyngeal
examination.2 While patients’ face masks obviously
need to be removed during these procedures, clinicians are strongly
encouraged to follow personal protection guidelines, wearing all the
proper personal protective equipment (PPE) such as N95, FFP3 or FFP2
masks, gown, cap, eye protections (goggles and face shields), and
gloves.2 In addition to this, all non-urgent elective
intervention and follow-up visits should be conceivably procrastinated
and the treatment of time-sensitive cases, as cancer patients, should be
discussed on a case-by-case basis minimizing the risks of
contamination.2
In the field of Otorhinolaryngology there are urgent microsurgical
procedures, such as mastoidectomy for otologic meningitis, or not
deferrable oncologic surgeries on the upper aerodigestive tract, that
should reasonably be performed even if dealing with suspicious or
confirmed COVID-19 patients. Nevertheless, the unmodifiable necessity of
the operating microscope, or the robotic da Vinci robotic surgical
system, impede a proper use of the overcited PPE, since the protective
glasses or face mask hinder the surgeon’s eyes to lean directly against
the microscope ocular or the da Vinci console.2 In
order to find a feasible alternative to the traditional microsurgery
setup, it is herein proposed a possible solution with an innovative
exoscopic setting based upon a 4K 3D system of vision.