A Tubular-Mounted Digital Camera Versus Optical Surgical Microscope for Minimally Invasive Lumbar Decompression Surgery: The Impact on Operative Times, Ergonomics, and Workflow

Abstract

ObjectivesUnderstanding the ergonomic impact is foundational to critically evaluate the value and safety of enabling technologies in spinal Minimally Invasive Spine Surgeries (MISS). This study assessed the impact of tube-mounted digital camera (TMDC) vs. optical surgical microscope (OSM) in single-level MISS on operative times, durotomy rate, surgeon ergonomics, safety, and operating room workflow. MethodsIn a retrospective study, we compared consecutive single-level MIS lumbar decompression surgeries with TMDC (Sep 2021-Jun 2022) to a historical OSM cohort (Jan 2020-Jul 2021). Data included patient demographics, operative times, durotomy incidence, surgeon ergonomics (REBA scores), and equipment impact via staff surveys. T-tests assessed operative times, while Pearson chi-squared tests compared sex. Age, BMI, and CCI comparisons used Wilcoxon rank-sum tests, and survey results were analyzed with Wilcoxon signed-rank tests. ResultsIn total, 74 and 82 patients were included in the TMDC and OSM groups, respectively. Age, sex, and CCI did not significantly differ between both groups. The TMDC group had a higher BMI (29. 6 ± 5.1) versus the OSM group (29.0 ± 7.5) (p=0.04). The TMDC group (n=74) had significantly shorter operative times (57.3±16.6 minutes) compared to the OSM group (n=82) (66.7±22.5 minutes) (p=0.004), with no difference in durotomy rates (p=0.42). TMDC use yielded lower REBA scores (3) vs. OSM (4.1±0.77) (p<0.001). Surveys indicated improved safety, setup time, and workflow with TMDC (p<0.001). ConclusionsTMDC in single-level MIS lumbar decompression surgery improved surgeon ergonomics, reduced operative times, and maintained durotomy rates, enhancing operative room efficiency. Evaluating technology's ergonomic impact is vital for safety and value assessment.