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The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial
Georgios Pafitanis1,2,3, Michalis Hadjiandreou3, Alexander Alamri4
1Group for Academic Plastic Surgery, Microvascular Anastomosis Simulation Hub, The Blizard Institute, Queen Mary University of London, London, UK.
Archives of Plastic Surgery
|May 27, 2020
Summary
The Exoscope is non-inferior to the operating microscope for microvascular anastomosis in experts. While initially more time-consuming, the Exoscope offers comparable end-product quality and a steep learning curve.
Area of Science:
- Microsurgery
- Surgical Technology
- Vascular Surgery
Background:
- The Exoscope is a novel high-definition digital camera system.
- Limited evidence exists for exoscopic devices in microsurgery.
- This study evaluates the Exoscope as an alternative to the operating microscope (OM) in simulated microvascular anastomosis.
Purpose of the Study:
- To objectively assess the Exoscope's effect on expert microsurgeons' performance.
- To compare the Exoscope to the standard operating microscope (OM) in simulated microvascular anastomosis.
- To evaluate the learning curve associated with exoscopic microvascular anastomosis.
Main Methods:
- Expert microsurgeons performed standardized tasks using the Modus V Exoscope and OM.
- Hand-motion analysis measured total pathlength (TP), total movements (TM), and total time (TT).
- Non-inferiority of TT was assessed using a clinical margin; exoscopic learning curve was determined.
Main Results:
- Statistically significant differences were found in TP, TM, and TT for micro sutures.
- TM and TT showed statistical significance for anastomoses, with marginal non-significance in TP.
- No significant differences in intimal suture line quality; Exoscope anastomoses were non-inferior to OM (absolute TT difference of 0.07 minutes).
Conclusions:
- Exoscope anastomoses performed by experts are non-inferior to OM anastomoses.
- Exoscopic microvascular anastomosis is more time-consuming but yields clinically non-inferior end-product patency.
- The expert learning curve for exoscopic use is steep but rapid, potentially reaching clinical equality.
