Abstract
BackgroundPromoting a disruptive innovation in microsurgery, exoscopes promise alleviation of physical strain and improved image quality through digital visualization during microneurosurgical interventions. This study investigates the impact of a novel 3D4k hybrid exoscope (i.e., combining digital and optical visualization) on surgical performance and team workflow in preclinical and clinical neurosurgical settings.MethodsA pre-clinical workshop setting has been developed to assess usability and implementability through skill-based scenarios (neurosurgical participants n = 12). An intraoperative exploration in head and spine surgery (n = 9) and a randomized clinical study comparing ocular and monitor mode in supratentorial brain tumor cases (n = 20) followed within 12 months. Setup, procedure, case characteristics, surgical performance, and user experience have been analyzed for both ocular group (OG) and monitor group (MG).ResultsBrain tumor cases using frontal, frontoparietal, or temporal approaches have been identified as favorable use cases for introducing exoscopic neurosurgery. Mean monitor distance and angle were 180 cm and 10°. Surgical ergonomics when sitting improved significantly in MG compared with OG (P = .03). Hand-eye coordination required familiarization in MG. Preclinical data showed a positive correlation between lateral camera inclination and impact on hand-eye coordination (rs = 0.756, P = .01). There was no significant added surgical time in MG. Image quality in current generation 3D4k monitors has been rated inferior to optic visualization yet awaits updates.ConclusionsThe hybrid exoscopic device can be integrated into established neurosurgical workflows. Currently, exoscopic interventions seem most suited for cranial tumor surgery in lesions that are not deep-seated. Ergonomics improve in monitor mode compared to conventional microsurgery.
Highlights
Microsurgery is being facing a new trend: the convergence of endoscopic and microscopic visualization principles resulting in lighter and more versatile surgical exoscopes
Preclinical and clinical data is available for six exoscopic devices by different manufacturers, all of which benefit from recent technology improvements
Preferred positions of the external monitor were next to the OR table in direct sight axis to the surgeon with the exoscope positioned overhead
Summary
Microsurgery is being facing a new trend: the convergence of endoscopic and microscopic visualization principles resulting in lighter and more versatile surgical exoscopes. For many exoscopes directly base on the principles of endoscopy, they reproduce its inherent dissociation of working and viewing direction. These machines promise to facilitate improvements in OR team visualization and surgical ergonomics [29]. To assist its clinical investigation, we set up a mixed method-study design focusing on identification of eligible cases, assessment of usability, analysis of device impact on surgical performance and team workflows, and exploration of visual quality standards in microneurosurgery. This study investigates the impact of a novel 3D4k hybrid exoscope (i.e., combining digital and optical visualization) on surgical performance and team workflow in preclinical and clinical neurosurgical settings. Image quality in current generation 3D4k monitors has been rated inferior to optic visualization yet awaits updates
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
