To the Editor:

We carefully reviewed the letter from Ceraudo et al. in reply to our technical note [5], and we sincerely thank the Editor for giving us the opportunity to debate about this topic.

We appreciated their favorable opinion regarding the endoscopic diving technique (EDT), which we introduced in our surgical practice for a long time. It allows, among many other things, to hydro-dissect tumor remnants and to improve the visualization of the surgical field in an “underwater” fashion, as described elsewhere [3, 4].

Ceraudo and colleagues had previously provided their preliminary experience with this technique by adopting a different system from ours, that separates the irrigation source from the optic [1]. This modification may require more space and less freedom of movement inside the surgical cavity, but it is useful in the perspective of looking for innovations. Since then, their proficiency seems to be further improved through the integration of Ultra High Definition and 4K systems, along with other irrigation devices from various medical companies.

In the last few years, several papers have been published on the use of EDT in skull base surgery: this testifies a growing consideration [1, 2]. It will certainly be interesting to know new up-to-date case histories even from other different groups and to analyze their learning curve after the application of this technique in everyday surgical activity. We rely that a significant step forward will be performed as soon as specific tools will be available, so that they could allow working underwater, similarly to intraventricular neuroendoscopy.