HCTM Performs First Robotic-assisted Endoscopic Ear Surgery In Malaysia

By Atira Khalisha Nor Adnan

KUALA LUMPUR, March 25 (Bernama) -- Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, has made history as the first hospital in the country to successfully perform endoscopic ear surgery using a combination of two advanced technologies.

The procedure, carried out on March 12, was performed on a 59-year-old female patient suffering from hearing loss in her right ear. It combined piezoelectric surgical technology (piezosurgery) with a robotic endoscopic holder.

Associate Prof Dr Noor Dina Hashim, a consultant at the Otology, Neurotology and Lateral Skull Base Unit at HCTM’s Department of Otorhinolaryngology-Head and Neck Surgery, said the robotic endoscopic holder ensures stable, high-clarity imaging of the surgical area, enabling the surgeon to operate more efficiently using both hands throughout the procedure.

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“Previously, endoscopic surgery required the surgeon to hold the endoscope in one hand and surgical instrument in the other. The hand holding the endoscope had to remain extremely steady to maintain a clear view, which could lead to fatigue.

“With the robotic arm holding the endoscope, the image of the surgical area is stable and clear, and both hands of the surgeon are free, allowing them to do their work better and with greater control. In confined spaces such as the ear canal, having both hands free is especially beneficial for controlling bleeding and cutting tissue,” she said in a recent interview with Bernama.

Dr Noor Dina explained that the robotic endoscopic holder is specifically designed to assist surgeons in performing procedures in small, hard-to-reach anatomical areas with greater stability and precision, particularly in the middle ear.

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She added that the device is easy to assemble and operate, allowing specialists to adapt to its use within a short period.

The March 12 surgery, led by Dr Noor Dina and assisted by otorhinolaryngologist Dr Wan Nabila Wan Mansor, also utilised a piezo scissor cutter to cut the bone without damaging the surrounding soft tissues. This marks the first time the technology, commonly used in dentistry, has been applied in endoscopic ear surgery in Malaysia.

“Before the introduction of the piezo cutter, we used a rotary drill to cut the bone. However, it could also cut surrounding tissues, posing risks and potential complications.

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“With the piezo scissor cutter, the cutting is more precise and targeted exclusively at the bone, without affecting surrounding tissues. Even if there is a slight deviation, it does not injure the surrounding tissues,” she said, noting that the middle ear contains many critical structures such as the facial nerve and auditory bones.

On its impact on patients, Dr Noor Dina said the use of these technologies can help shorten surgery time, speed up recovery and reduce pain compared with conventional methods.

“In our recent case, this was the patient’s second surgery on the same ear. She reported minimal pain and was discharged the following day,” she said.

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However, she noted that not all ear procedures are suitable for this technology as piezo surgery is less effective in cases involving very dense bone or soft tissue.

Procedures that may benefit from this technology include cortical mastoidectomy, endoscopic sinus surgery and operations involving the mandible or skull base.

“This technology is not suitable for soft tissue procedures such as tonsil, adenoid or nasal polyp surgery, or tumour removal. It is also less ideal for cases requiring extensive cutting of dense bone as it may prolong the duration of surgery,” she said.

-- BERNAMA