A high-definition 3D exoscope as an alternative to the operating microscope in spinal microsurgery

Area of Science:

• Neurosurgery
• Spinal Surgery
• Surgical Technology

Background:

• The operating microscope (OM) has been the standard for spinal microsurgery since the 1970s.
• Limitations of OM include size, cost, limited movability, and surgeon discomfort due to posture.
• Exoscopic video telescopes are being explored as alternatives to the OM.

Purpose of the Study:

• To evaluate the feasibility of a new 3D exoscope as an alternative to the OM in spine surgeries.
• To compare operative parameters, outcomes, and surgeon comfort between 3D exoscope and OM use.

Main Methods:

• A prospective cohort study comparing a 3D exoscope with the OM in single-level lumbar or cervical spinal surgery.
• 40 patients for lumbar posterior decompression (LPD) and 20 for anterior cervical discectomy and fusion (ACDF) using the 3D exoscope.
• Matched controls treated with OM; assessment of operative time, blood loss, symptom improvement, and surgeon comfort via questionnaire.

Main Results:

• No significant differences in operative time or blood loss between 3D exoscope and OM groups for LPD and ACDF.
• Postoperative symptom improvement was comparable (ACDF/NDI: p=0.43; LPD/ODI: p=0.76).
• Surgeon comfort was rated superior with the 3D exoscope, particularly for challenging procedures, though visualization/illumination was inferior for ACDF and long approaches compared to OM.

Conclusions:

• The 3D exoscope is a safe alternative for common spinal procedures, offering enhanced surgeon comfort.
• Visualization and illumination quality with the 3D exoscope remain slightly inferior to the operating microscope.
• Further advancements in 3D exoscope technology may address current visualization limitations.