Technology in rhinology surgery - evaluating new developments and clinical challenges

Since its first introduction in 1945, endoscopes transformed visualisation of the surgical field and allowed for minimally invasive surgery in previously major open procedures. Despite the obvious success of this technology, the specific drawbacks of working within a two-dimensional (2D) environment included impaired depth perception. This made the navigation of highly variable anatomical structures subjectively difficult. This limitation was addressed with a three-dimensional (3D) endoscope. The first part of this thesis (chapter 2 and 3) aimed to fill the knowledge gap concerning endoscopic endonasal surgery with regards to the skull base. The second part (chapter 4, 5, 6, and 7) evaluated the use of 3D technology within the field. This included the first uses of the endoscope clinically, reproducible pilot studies and randomised controlled trials, as well as technological assessments with traditional models. The last part of this thesis (chapter 8) focused on consolidating all the available information to provide an overall assessment of the new 3D endoscope.