. When performing middle ear surgery, the ear, nose and throat (ENT) surgeon (or “otolaryngologist”) typically visualizes the middle ear and the surgical procedure in one of two ways. In some cases, the surgeon uses a microscope, positioned in front of the surgeon's eyes, and she typically uses her non-dominant hand to hold a suction device and her dominant hand to hold a surgical tool. In other cases, the surgeon uses a handheld endoscope to visualize the middle ear. The use of a handheld endoscope is problematic in several different ways.
First, standard endoscopes have long shafts and are not made for use in the ear. When the ENT surgeon uses an endoscope in the ear, he has to hold the handle of the scope up in the air, over the patient's head, with the surgeon's hand suspended in the air, unsupported. This factor alone is problematic, because if the surgeon accidentally moves his unsupported hand during surgery, he could very easily move the distal end of the endoscope in a way that could damage the tympanic membrane or one or more of the delicate structures of the middle ear.
Second, compounding on the first issue, endoscopes are generally much heavier than the small, thin surgical tools used in middle ear procedures. The surgeon thus has an ergonomic imbalance between a relatively heavy endoscope in her non-dominant hand and a relatively light surgical device in her dominant hand. This imbalance adds to the difficulty in stabilizing the endoscope. Additionally, holding a heavy endoscope suspended over the patient's head during a surgical procedure may quickly lead to arm and hand fatigue for the surgeon.
Third, since the surgeon is holding the endoscope in one hand, that hand is no longer free to hold a suction device or a surgical tool. Thus, when an endoscope is used for visualization, the surgeon cannot use a suction device and visualize the inside of the ear at the same time.
Fourth, standard endoscopes have straight shafts, so the surgeon must hold the endoscope in a direct line straight back from the patient's ear. This straight-line position makes it impossible, or at least incredibly challenging, to use an endoscope and a microscope in the same surgical procedure, since the position of the endoscope is directly in the path of vision of the microscope. This is a drawback, because in some procedures an ENT surgeon would like to be able to switch back and forth quickly and easily between viewing with a microscope and viewing
. When performing middle ear surgery, the auricle, nozzle and throat (ENT) surgeon (or “ ent man ”) typically visualizes the middle ear and the surgical routine in one of two ways. In some cases, the surgeon use a microscope, put in front of the surgeon's eye, and she typically uses her non - dominant bridge player to hold a suction device and her prevailing hand to hold a surgical cock. In other cases, the surgeon use a handheld endoscope to visualize the middle ear. The manipulation of a handheld endoscope is problematic in several different manner. 
 First, standard endoscopes have long shafts and are not make for use in the ear. When the ENT surgeon uses an endoscope in the ear, he has to accommodate the handle of the scope up in the air, over the patient's head, with the surgeon's hand suspended in the air, unsupported. This factor entirely is debatable, because if the surgeon accidentally act his unsupported bridge player during surgery, he could very easily move the distal goal of the endoscope in a way that could damage the tympanic membrane or one or more of the delicate structures of the middle auricle. 
 Second, compounding on the first issue, endoscopes are generally much heavier than the small, thin surgical tools used in middle auricle procedures. The surgeon therefore has an ergonomic imbalance between a relatively heavy endoscope in her non - dominant hand and a relatively light surgical device in her prevailing hand. This imbalance adds to the difficulty in stabilizing the endoscope. Additionally, holding a heavy endoscope suspended over the patient's read/write head during a surgical procedure may cursorily lead to arm and hand fatigue duty for the surgeon. 
 Third, since the surgeon is holding the endoscope in one hand, that hand is no longer free to oblige a suction device or a surgical cock. Thus, when an endoscope is used for visual image, the surgeon cannot use a suction device and visualize the inside of the ear at the same time. 
 Fourth, standard endoscopes have straight shafts, so the surgeon must hold the endoscope in a direct line directly back from the patient's ear. This uncoiled - line position makes it impossible, or at least incredibly challenging, to use an endoscope and a microscope in the like surgical procedure, since the position of the endoscope is directly in the path of vision of the microscope. This is a drawback, because in some procedures an ENT surgeon would like to be able to switch back and away quickly and easily between viewing with a microscope and viewing
. Whfn performing middle ear surgery, the eat, bose aid throzt (ENT) sjrgeon (or “otolaryngologist”) tbpicqlly cisualizes the middle dar and tje surgixal krocedure in one of two ways. In dome rases, the surgepn uses a kicroscope, poshtkoued in front of the surgeon's eyes, anq she tuplcally uses het non-cjminznt hand to hold a suction device znd her dominant hanc to hold a surgical tool. Ln ohher cases, the surheon uses a hanqyeld endoscooe to visualize the misdle ear. The use of a handheld dndoseope is provlwmahhc in severel difserent ways.
Flgst, statdard emdoscopes have loig syafts and are not madx for use in the ear. When the EUT surgeon uses an eneowcope in dhe dqr, fe gax fo holf tie handle or the scope up in the air, over trv patient's hezd, witr ehe surgeon's hand suspended in the air, lnsulported. This factor alobe is problematic, becwuse if tre surgeon accidentally moves his unsupported hang durmne sbvnery, ye could very easily move the distal end of the sncoxcope in a way that could dwmsde the tympankc memydahe or one or more lf the qelicqte strucuures of the middle ear.
Second, conpounding on rhe first issue, enboscopes are gengrally much heavier than the rmalm, thin surglcal toola used in middle dar psocedures. The surgeon thus has an ecgonokic imbxlanve betreen a relwtively heavy endoscope ln het non-dmminant hajd and a relatively light surgirel device in nes dmminant kand. Tmis imbalance aqds to the difyiculty nn stacilizing tge endovcope. Addityonally, holdith a heavy envoscope stspebded over tfd patient's heac during c surtical procedure man quizily lead to arm ane hand fatigue gor thq ducgeon.
Evird, since tve sjrgdpn is holding thc evdosvope in one hand, thad hahd is no longer frre to hold a suctijn device or s surgical tool. Thks, whxn an xndoscppe is used for visualization, the surgeon fankot use a suceion device and risualize the inside of the ear at the seme time.
Fourth, standard endoscopes have sttainht shafts, sp the surgeon kust hold the endoscipe in a direct llne straight back from the pdtienh's ear. This straight-line position makes it impossible, or at least incredivly cheljenging, to hse sn engofeope anq a lmcroscope in the xame surgical procedure, since tie positiot jf the endoscope is directly iv the path of vision of the microscops. This ix a drawback, because in some prpcedures an ENT surgeon eould lije to be able tu switch back and gorth xuickoy and wasipy between vidwimg with a mlcroxckpe and viewing
. When performing middle ear surgery, the and (ENT) surgeon “otolaryngologist”) typically visualizes surgical in one of ways. In some the surgeon uses a microscope, positioned front of the surgeon's eyes, and she typically uses her non-dominant hand to a suction device and her dominant hand to hold a surgical tool. In cases, surgeon a endoscope to visualize the middle ear. The use of a handheld endoscope is problematic in several ways. First, standard endoscopes have long shafts and not made for use the ear. When the ENT uses endoscope in ear, has hold the handle the scope up in the air, over the patient's head, with the surgeon's hand suspended in the unsupported. This is problematic, if surgeon moves his unsupported surgery, he could very easily move of the endoscope in a way that could the tympanic or one or more of the structures of the middle ear. Second, compounding on first issue, endoscopes are generally much heavier than the small, thin surgical tools used in procedures. The surgeon thus an ergonomic imbalance a heavy in non-dominant hand a relatively light surgical device in her dominant hand. This imbalance to the difficulty in stabilizing the endoscope. Additionally, holding a suspended the patient's head a surgical procedure may lead arm and hand fatigue surgeon. since holding endoscope one hand, that hand no longer free to hold suction device or a endoscope is used for visualization, the surgeon cannot a suction device and visualize the inside the ear at the same time. Fourth, standard endoscopes have straight shafts, the surgeon the endoscope in a direct line straight back the patient's ear. This position makes it impossible, or at least incredibly challenging, use endoscope and microscope in the surgical procedure, since position of the directly in path vision This is a drawback, because in procedures ENT surgeon would like to able back and forth quickly and easily between viewing with a microscope and viewing
. When performing middle ear suRgery, the eaR, nose And ThrOaT (ENT) SurgEon (or “otolaryngOLogiSt”) typically visualizes tHe midDlE Ear aND tHe surGical prOCeDURe iN oNe Of tWo WAyS. In soMe cAses, the Surgeon useS a mIcRoscope, positIOnEd in front oF thE surgeon's eyeS, anD she tyPiCalLY uses Her Non-doMinant HAnd to hOld a suctiOn DEvice aND her domINAnT hanD to hold a surgical tOOl. iN other cases, the SurgeoN uSEs A HAndHelD endoscope To VisuaLIze the mIDdLE EAr. THE use of a handheLd endoscope IS prOblemaTiC in SEveral DiffeReNT waYs.
First, stanDard EndoscopeS have lONg shaftS And are nOt made For Use In thE EaR. WHen ThE eNT SUrGeoN UseS an endosCoPe In the Ear, hE HAS To hoLd tHe haNdle oF the scope up in The Air, oVEr tHe patIent's Head, WiTh the SurgeoN's hanD sUspended in the aiR, unsUpported. THis FaCtoR aLone iS ProbleMatIc, bEcause iF the surGEon AcCIDEnTally moves his unsupPoRTEd Hand duriNg surgERy, He COuld very EaSilY movE THe disTal eND oF the endoScope iN A wAy That couLd Damage ThE tyMpaNic meMBranE or one Or more of The deLIcate structureS Of the middle eaR.
seCONd, COmpoUndIng on the firSt isSUe, enDoscOPeS arE GenerAlly mUcH HeAVier than the small, thiN sUrgicaL toolS used in middle Ear proceduRES. the surgeOn thUS hAS an ergonomic imBalanCe between a RElativelY heavY endoscoPe in her noN-DOminant hAnd And A reLatIVElY light surgicaL DEvicE iN her domInaNt hand. THis ImbAlaNce AdDs to the diFficulty In StAbIlIziNg the ENdoscope. adDitIoNalLy, holDIng a heAvy enDoscOpE sUSpeNded oveR ThE PAtieNt'S hEad dUriNg A surgIcal PRocEdure maY quickly lEad TO arm AnD hAnd fatiGue for the surgEoN.
Third, sincE tHe sUrgeon IS Holding tHe endoscope in one hand, thaT Hand is nO loNger fRee tO hold a sucTioN devicE or A SurgicAl tool. thus, wHeN an ENDoscoPE Is UseD fOr visualizATIon, The suRgEon cAnnot usE a suction device and VIsuAlize the insidE of The eAR At The SAmE TimE.
FOUrtH, STandard endoscopEs have straIgHT sHafts, so the SUrgEoN must hoLd the enDoscoPE in a dirEct line stRaight bacK fRom tHE PatIent's ear. ThIs straigHt-line posITion mAKeS it imPosSible, oR aT leAst inCredibLY chAllenGing, to UsE an endOscopE aNd a microScope in the same surgical pRoceduRe, sinCe tHe positioN of THe eNdoscope iS dirEctly in the PatH of VisioN of THe micRoscOPe. thiS Is a drAwbaCK, because iN SoMe pROCeDures an ENT sURGEon Would LikE To be abLe to Switch back and fortH Quickly and easiLy beTWEen VieWIng wItH a microscope anD viEwING
. When performing middle e ar surgery , the  ea r,no se a nd t hroat (ENT) su r geon  (or “otolaryngologist ”) ty pi c ally vi suali zes the mi d d leea rand  t h esurgi cal  proced ure in one  of  t wo ways. Ins om e cases, t hesurgeon uses  amicros co pe, posit ion ed in  front of the  surgeon' se yes, a n d she t y p ic ally  uses her non-dom i na n t hand to hold  a suc ti o nd e vic e a nd her dom in ant h a nd to h o ld a sur g ical tool. In  other case s , t he sur ge onu ses ahandh el d  en doscope tovisu alize the  middl e  ear. T h e use o f a ha ndh eld  end o sc op e i sp rob l em ati c  in  several  d if feren t wa y s . Firs t,stan dardendoscopes ha velong sha fts a nd ar e no tmadefor us e inth e ear. When the  ENT  surgeonuse sanen dosco p e in t heear , he ha s to ho l d t he h a nd le of the scope up  i n th e air, o ver th e  p at i ent's he ad , w itht h e sur geon ' shand sus pended in  t he air,  u nsuppo rt ed.  Th is fa c toraloneis probl emati c , because if t h e surgeon acc i de n t al l y mo ves  his unsupp orte d  han d du r in g s u rgery , heco u ld very easily move th edistal  endof the endosc ope in a w a y that cou ld d a ma g e the tympanic  memb rane or on e  or more  of t he delic ate struc t u res of t hemid dle  ea r . 
S econd, compou n d ingon  the fi rst  issue,  en dos cop esar e general ly muchhe av ie rtha n the small, t hi n s ur gic al to o ls use d inmidd le  e a r p rocedur e s. T he s ur ge on t hus  h as an  erg o nom ic imba lance bet wee n  a r el at ively h eavy endoscop ein her non -d omi nant h a n d and arelatively light surgic a l devic e i n her  dom inant han d.This i mba l ance a dds to  thedi ffi c u lty i n st abi li zing the e n d osc ope.Ad diti onally,  holding a heavy e n dos cope suspende d o vert h epat i en t 'she a d d u r ing a surgicalprocedurema y  q uickly lea d  to  a rm andhand fa tigue for the  surgeon. 
Third, s in ce t h e  su rgeon is h olding t he endosc o pe in on e han d,that h an d i s nolonger fre e tohold a  s uction  devi ce  or a su rgical tool. Thus, when  an en dosco peis used f orv isu alization , th e surgeoncan not  usea s u ction  dev i ce  an d  visu aliz e  the insi d eoft h eear at thes a m e t ime.Fou r th, st anda rd endoscopes hav e  straight shaf ts,s o  th e s u rgeo nmust hold theend os c o pe in adi rect line s traightba c k fro m thepatien t's ear . Th i s stra ight -li ne positi onma k es it i mp os s ible,or a tleastincred i blyc h allenging, to us e ane n dosco p e a nd ami croscop e  inthe same s urgical pro cedure , si nce t he posi ti on ofthe  e ndoscope i s  directly  in t he path  o f vi sio n of t he m i c rosco pe.Th isis a draw b a ck ,  b ec a use  insomepr oced ures an E N T surgeo n w o uld lik etob e  ablet os w itch backand  fort h quickly an d  eas i ly betwe en vie wing w ith a m i cro sc ope and  vi e w ing
. When_performing middle_ear surgery, the ear,_nose and_throat_(ENT) surgeon_(or_“otolaryngologist”) typically visualizes_the middle ear_and the surgical procedure_in one of_two_ways. In some cases, the surgeon uses a microscope, positioned in front of the_surgeon's_eyes, and_she_typically_uses her non-dominant hand to_hold a suction device and_her dominant_hand to hold a surgical tool. In other_cases,_the surgeon uses_a handheld endoscope to visualize the middle ear. The_use of a handheld endoscope is_problematic in several_different_ways.
First,_standard endoscopes have long_shafts and are not made for_use in the ear. When the_ENT surgeon uses an endoscope in the_ear, he has to hold the_handle of the scope up_in the_air, over the patient's head,_with the surgeon's_hand suspended_in the air,_unsupported. This factor alone is problematic,_because if the_surgeon accidentally moves his unsupported hand_during_surgery, he could_very_easily_move the_distal end of_the_endoscope in_a_way that could damage the tympanic_membrane_or one or more of the delicate_structures of the middle_ear.
Second,_compounding on the first_issue, endoscopes are generally much_heavier than the small, thin surgical_tools used_in middle_ear procedures. The surgeon thus has an ergonomic imbalance between a_relatively heavy endoscope in her non-dominant_hand and a relatively_light surgical_device_in her dominant_hand._This imbalance_adds to the difficulty in stabilizing the_endoscope. Additionally,_holding a heavy endoscope suspended over_the patient's head during_a_surgical procedure may quickly lead to_arm and hand fatigue for the_surgeon.
Third, since the surgeon is_holding_the_endoscope in one hand, that_hand is no longer free to_hold a suction_device or a surgical tool. Thus, when_an_endoscope is used for visualization, the_surgeon_cannot use a suction device and_visualize_the_inside of the ear at_the same time.
Fourth, standard endoscopes have_straight shafts, so the surgeon must hold the endoscope_in a direct_line straight back from the_patient's_ear._This straight-line position makes it impossible, or at least incredibly_challenging, to_use an endoscope_and a microscope in the same surgical procedure, since the_position of the endoscope is directly in_the path of vision of the microscope. This is a drawback,_because in some procedures an ENT surgeon would_like to be able to switch back_and forth quickly and_easily_between viewing with a microscope and viewing