Introduction: Cochlear implantation surgery is a field of expanding possibilities. Conventionally, these surgeries were performed via the posterior tympanotomy approach using operating microscopes. The benefits of microscopic ear surgery include excellent visualization, binocular vision and two-handed surgery but limited visualization in deeper recesses and need for soft tissue retraction/additional bony drilling are definite disadvantages. The advent of flexible, rigid and angled endoscopes helped to overcome certain perceived drawbacks of microscopes in addition to providing higher resolution, greater magnification, a wider field of view and superior illumination. However, the major limitation of endoscopes is the lack of two-handed instrumentation and heat generation in the operative field. How we did it While endoscopes are accepted adjuncts or even alternatives to microscopes in ear surgery, we present our experience of performing cochlear implantation surgery by Veria technique without the use of either equipment in two patients. This was made possible by the VITOM - 3D system with its IMAGE 1 PILOT which provides excellent 3-D visualisation with the additional advantages of two-handed surgery, no need of repeated handling and adjustment of equipment or additional retraction, better ergonomics and shorter surgical time.

Conclusion: Cochlear implantation surgery without the need of operating microscopes or endoscopes maybe possible with the advent of 3-D visualization systems like VITOM 3D by combining the advantages of both equipments while bypassing the drawbacks of either. Our two-case experience highlights the unexplored potential of this revolutionary technological advancement in cochlear implantation surgery.