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 11^th March. To date (24^th 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.