Microscopic Versus Endoscopic Stapes Surgery: A Systematic Review and
Meta-analysis
Abstract
Objectives Endoscopic approaches constitute a newly introduced and
promising technique in the field of stapes surgery, presenting favorable
outcomes, so far. This study aims to compare endoscopic and microscopic
stapes surgery based on current literature evidence, in terms of their
efficacy and safety characteristics. Design We conducted a systematic
literature search of three medical databases (Pubmed, Cochrane Library,
and Scopus). We focused on randomized controlled studies or
observational studies comparing microscopic to endoscopic stapes
surgery. Data related to the efficacy and safety of each technique were
extracted. Outcome data were summarized using the pooled mean
differences or pooled odds ratio along with their 95% confidence
intervals, according to the available data. The quality of evidence was
assessed according to the GRADE recommendations. Results Thirteen
studies with 705 patients were included in the meta-analysis. Success
rate was evaluated by estimating air-bone gap improvement, resulting in
comparable outcomes for the two techniques (mean difference: -0.20; 95%
CI: -0.53, 0.14). No statistically significant difference was detected
concerning postoperative complications, except for dysgeusia that was in
favor of the endoscopic approach (OR: -1.46; 95% CI: -2.45, -.047). The
overall quality of evidence was assessed to range from “Low” to “Very
Low”. Conclusion Endoscopic stapes surgery is an innovative alternative
to the microscopic technique, resulting in commensurate outcomes in
terms of success rate and complications. Further high-quality studies
are needed, to adequately compare the two approaches, particularly in
terms of operation time, learning curve, cost-effectiveness, and otology
surgical skills acquisition.