Why Direct Vision?

When I present the Endomidface by Direct Vision, the first reaction is always the same: "But Dr. Robério, isn't this a step backward? Isn't abandoning the endoscope going back in time?"

It's a fair question. And it deserves an honest answer.

The Myth of Linear Progress

There's an implicit belief in medicine that "more technology = better results." The endoscope looks modern. The video tower impresses. The patient feels they're receiving "the most advanced treatment."

But technology is a tool, not an end. The right question isn't "which equipment to use?" — it's "what gives me the best result with maximum safety?"

What I Lost with the Endoscope

For years, I operated with endoscopy. I mastered the technique. I had consistent results. But something bothered me:

• Hand-eye dissociation: You look at a monitor while your hands work somewhere else. The brain needs to constantly translate.
• Loss of tactile feedback: The camera shows, but doesn't feel. The difference between "almost on the nerve" and "on the nerve" is sometimes millimetric.
• Equipment dependency: Tower malfunction? Camera fogged? Surgery compromised.
• Cruel learning curve: 50, 80, 100 cases to feel real confidence. How many avoidable complications along the way?

What I Gained with Direct Vision

The transition wasn't immediate. It was years of technical evolution, refining accesses, lighting, positioning. Until arriving at a method that offers:

• Simultaneous tactile + visual feedback: You see AND feel. At the same time. In the same plane.
• Reduced learning curve: 15-30 cases for safety. Not 100.
• Total autonomy: I don't depend on expensive equipment, camera-trained assistant, or luck with technology.
• Immediate adaptation: Unexpected anatomy? I adjust on the spot. No time lost repositioning camera.

The Numbers Speak

212 consecutive cases of Endomidface by Direct Vision. Zero permanent nerve injury.

This is not luck. It's method. It's the logical consequence of a technique that prioritizes safety over impression.

The Right Question

So no, direct vision is not a step backward. It's evolution. It's understanding that the best instrument is the one that connects you to the patient — not the one that separates you from them.

The question isn't "endoscope or not?". It's: "what allows me to operate with maximum safety and consistent results?"

For me, after 18 years, the answer is clear.