The 3D-Robotic Exoscope Compared With the Microscope in Cochlear Implant and Translabyrinthine Surgery.

Area of Science:

• Neurosurgery and Otolaryngology
• Surgical Technology and Innovation
• Ergonomics and Occupational Health

Background:

• The traditional surgical microscope presents ergonomic challenges and limitations in visualization for complex procedures.
• The three-dimensional (3D) exoscope has emerged as a novel viewing platform with the potential to enhance surgical ergonomics and performance.
• Evaluating the comparative benefits of 3D exoscopes versus microscopes is crucial for advancing microsurgical techniques.

Purpose of the Study:

• To systematically evaluate the ergonomic characteristics of a 3D exoscope system.
• To compare the visualization capabilities of the 3D exoscope against the surgical microscope.
• To assess subjective surgical performance in cochlear implantation (CI) and translabyrinthine resection of vestibular schwannomas (VS) using both platforms.

Main Methods:

• A prospective qualitative study conducted at a tertiary referral center.
• Ergonomic assessment using subjective questionnaires and the Rapid Upper Limb Assessment Tool (RULA).
• Comparative evaluation of visualization and performance parameters at key surgical milestones for exoscope and microscope.

Main Results:

• The 3D exoscope demonstrated significant ergonomic advantages, reducing surgeon strain in both subjective and objective measures (p < 0.001).
• Superior visualization (expansiveness, clarity, depth) was observed with the exoscope in VS and most CI procedures.
• Cochlear implantation surgeries were completed significantly faster using the exoscope (p = 0.007).

Conclusions:

• The 3D exoscope provides clear ergonomic benefits, reducing surgeon strain and potential long-term risks.
• Enhanced field of view and visual clarity were noted with the exoscope compared to the microscope.
• Further advancements in exoscope technology are expected to facilitate its adoption in CI and VS surgeries.