Abstract
The development of the three-dimensional (3D) exoscope is a marvel of technological innovation in modern surgical practice. While its predecessor, the operating microscope (OM), has long been the gold-standard surgical visualization modality, its particular limitations in terms of accessibility and ergonomic demand have led to the development of a more sophisticated, 3D model. Specifically, the 3D exoscope allows for an enhanced image quality of the surgical field, while also being more ergonomically favorable. Moreover, this device’s ability to handle delicate microsensitve procedures, along with its alleviation of surgeon fatigue, indicates great potential for neurosurgical application. For this narrative review, the authors queried PubMed database using the keyword “exoscope” to identify relevant studies involving the specialty of neurosurgery that were published in English language full text. The search yielded full-text English language-related articles regarding neurosurgical exoscope, its applications and limitations. The 3D exoscope uniquely allows for enhanced surgeon comfort and superior imaging of the patient’s real-time anatomy. However, the OM was described to having a slight image favorability with fusion and decompression surgery. Cost analysis is highlighted for its potential disparity. 3D exoscopes will potentially be incorporated with intelligent carriers and robotic surgical systems. Ultimately, with further studies highlighting its use, the 3D exoscope is expected to continue to imprint its status as one of the most efficient technological visualization tools in the future of neurosurgical practice.
Highlights
BackgroundThe incorporation of visual enhancement technology has transformed the field of neurosurgery
The exoscope system is composed of a scope positioned outside of the body cavity such that a high-definition (HD) view of the surgical field is projected onto a two-dimensional (2D) or 3D high-resolution monitor
Repositioning an exoscope is currently more complex and time consuming than adjusting an operating microscope (OM), which is equipped with more advanced mechanisms that allow for a comfortable single-handed repositioning
Summary
The incorporation of visual enhancement technology has transformed the field of neurosurgery. The close proximity of an OM to the surgical field is currently a limitation as it commonly blocks both the physical and visual paths across the operative field [37] This generally conflicts with the comfortable exchange of surgeon’s instruments, prompting need for intra-OR rearrangement around the OM, and may be further complicated depending on the dominant hand of the surgeon. Given the significant challenges to surgeons who wished to comply with hospital PPE mandates and maintain barrier precautions to minimize exposure, one hospital in Singapore reported their experience using the Modus V (Synaptive Medical) for emergency spinal trauma procedures [48] As they were able to retrofit their PPE goggles with the 3D glasses required to utilize the 3D exoscope, this allowed for excellent operative visualization while still maintaining PPE compliance and maximal barrier precautions [48].
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