Abstract
Background: Exoscopes are a safe and effective alternative or adjunct to the existing binocular surgical microscope for brain tumor, skull base surgery, aneurysm clipping and both cervical and lumbar complex spine surgery that probably will open a new era in the field of new tools and techniques in neurosurgery. Methods: A Pubmed and Ovid EMBASE search was performed to identify papers that include surgical experiences with the exoscope in neurosurgery. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) were followed. Results: A total of 86 articles and 1711 cases were included and analyzed in this review. Among 86 papers included in this review 74 (86%) were published in the last 5 years. Out of 1711 surgical procedures, 1534 (89.6%) were performed in the operative room, whereas 177 (10.9%) were performed in the laboratory on cadavers. In more detail, 1251 (72.7%) were reported as brain surgeries, whereas 274 (16%) and 9 (0.5%) were reported as spine and peripheral nerve surgeries, respectively. Considering only the clinical series (40 studies and 1328 patients), the overall surgical complication rate was 2.6% during the use of the exoscope. These patients experienced complication profiles similar to those that underwent the same treatments with the OM. The overall switch incidence rate from exoscope to OM during surgery was 5.8%. Conclusions: The exoscope seems to be a safe alternative compared to an operative microscope for the most common brain and spinal procedures, with several advantages that have been reached, such as an easier simplicity of use and a better 3D vision and magnification of the surgical field. Moreover, it offers the opportunity of better interaction with other members of the surgical staff. All these points set the first step for subsequent and short-term changes in the field of neurosurgery and offer new educational possibilities for young neurosurgery and medical students.
Highlights
The surgical microscope has represented a basic tool in neurosurgery since the late1960s, and it continues to be critically essential in the microsurgical treatment of brain and spine pathologies [1,2,3,4,5,6,7,8]
The use of the microscope requires that surgeons look directly through the surgical microscopic objective lenses to visualize the target area; it seems that this “face-to-machine” interface has been overcome due to the introduction and use of new digital 3-dimensional (3D) imaging exoscopes [2]
The development of the 3D exoscope represents a marvel of technological innovation in modern surgical practice, which continues to renew itself year by year, from the first 3D High Definition (HD) visualization exoscope to the most recent 3D 4K exoscope
Summary
The surgical microscope has represented a basic tool in neurosurgery since the late1960s, and it continues to be critically essential in the microsurgical treatment of brain and spine pathologies [1,2,3,4,5,6,7,8]. The development of the 3D exoscope represents a marvel of technological innovation in modern surgical practice, which continues to renew itself year by year, from the first 3D High Definition (HD) visualization exoscope to the most recent 3D 4K exoscope. These modern exoscopes are embedded with light filters for 5-aminolevulinic acid (5-ALA) and indocyanine video-angiography, pneumatic arms, adjustable operative settings, multiscreen output, longer focus distance, and greater magnification powers [13,14]
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