Microsurgical Wiltse Paraspinal Approach Using a Low-Budget Exoscope

Area of Science:

• Neurosurgery
• Medical Technology
• Surgical Instrumentation

Background:

• Access to microneurosurgical care is limited in low- and middle-income countries due to high equipment costs.
• Conventional operating microscopes are often unaffordable and difficult to maintain in low-resource facilities.

Purpose of the Study:

• To present an improved, low-cost exoscope system for microneurosurgery in resource-limited environments.
• To evaluate the system's performance in terms of magnification, illumination, image quality, and usability.

Main Methods:

• An improved exoscope system was developed using a 48-megapixel digital microscope camera, C-mount lens, ring light, and a two-link cantilever.
• The system projected the surgical field onto a 17.3-inch 2K monitor.
• Ten patients underwent exoscope-assisted transforaminal lumbar interbody fusion via the Wiltse paraspinal approach.

Main Results:

• The improved exoscope provided high magnification and illumination, comparable to conventional operating microscopes.
• The system offered superior affordability, image quality, and adjustability compared to the previous prototype.
• The setup was fast and intuitive, and the display provided a clear, bright image regardless of viewing angle.

Conclusions:

• Industrial microscope cameras are effective, low-budget alternatives for lumbar microdiscectomy in low-resource settings.
• The improved exoscope system enhances microneurosurgical care accessibility by offering superior affordability and performance.