Endoscopic surgery: A narrative review of history, safety, and future perspectives, with lessons for transcanal endoscopic ear surgery (TEES).

The history of endoscopic surgery since the laparoscopic revolution offers critical lessons for the safe development of transcanal endoscopic ear surgery (TEES). Endoscopy evolved through three interdependent technological domains-illumination, light transmission, and imaging. Within otolaryngology, endoscopic sinus surgery (ESS) was established by the 1990s, yet TEES did not achieve mainstream adoption until approximately 2010. This 25-year interval represents an unusual accumulation of translatable experience from other specialties. TEES therefore entered clinical practice with access to documented safety incidents, training frameworks, and corrective strategies developed in ESS, laparoscopic surgery, and gynecologic endoscopy. This review examines that historical record, draws direct parallels to TEES, and proposes a generational framework-Legends, Pioneers, Early Adopters, and Next Generation-to understand the current position of TEES in its developmental arc. The most consequential challenge facing the Next Generation is the progressive erosion of microscopic surgical experience as endoscopy becomes the primary training modality. A hybrid educational model integrating endoscopic and microscopic skills, in which conversion to microscopic technique is treated as sound clinical judgment rather than failure, is essential for the sustainable advancement of TEES. Emerging technologies-including digital twins for preoperative rehearsal, head-mounted displays, omnidirectional endoscopy, multispectral and fluorescence-guided imaging, and AI-based skill assessment-are expected to reach clinical implementation within the next decade and will redefine the capabilities and responsibilities of the next generation of otologic surgeons.