Comparative effectiveness of minimally invasive and conventional techniques in otologic surgery: A systematic review and meta-analysis

Background: Minimally invasive techniques (MITs) in otologic surgery, such as endoscopic ear surgery (EES), laser-assisted procedures, and robotic-assisted surgery, have gained popularity due to their advantages in reducing surgical trauma, improving precision, and enhancing recovery outcomes. However, a comprehensive comparison of MITs with conventional microscopic ear surgery (MES) regarding safety, efficacy, and longterm patient satisfaction remains underexplored. This systematic review and meta-analysis aim to synthesize evidence on the effectiveness of MITs versus conventional techniques in otologic surgery. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, Scopus, and Web of Science, following PRISMA guidelines. Studies comparing MITs and MES in patients undergoing otologic surgery were included. Key outcomes analyzed included hearing improvement (air-bone gap [ABG] and pure-tone average [PTA]), surgical duration, recovery time, recurrence rates, graft uptake success, and patient satisfaction. Statistical analyses included meta-analysis using a random-effects or fixed-effects model, heterogeneity assessment, and publication bias evaluation. Results: The review included multiple randomized controlled trials (RCTs), prospective cohort studies, and retrospective analyses. MITs demonstrated shorter surgical duration (mean difference: -11.41 minutes, p < 0.05) and faster recovery times compared to MES. Audiological outcomes (ABG and PTA) showed no significant difference between techniques. Recurrence rates were lower in the MIT group (4%) compared to MES (13%), indicating better disease clearance with minimally invasive approaches. Graft uptake success rates were high in both groups (MITs: 94%, MES: 92%), with no significant difference. Patient satisfaction was higher for MITs due to reduced postoperative pain, less scarring, and faster return to daily activities. Conclusion: Minimally invasive techniques in otologic surgery offer significant advantages in terms of reduced surgical duration, lower recurrence rates, and enhanced patient satisfaction, while maintaining comparable audio logical outcomes to conventional methods. However, challenges such as the learning curve and high initial costs limit widespread adoption. Further research, including long-term studies and integration of advanced technologies like artificial intelligence and augmented reality, is needed to refine MITs and improve accessibility in various healthcare settings.