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

The three-dimensional (3D) exoscope is an innovative viewing platform in microsurgery with the potential of offering improved ergonomics and surgical performance. This study systematically evaluated the ergonomic characteristics, visualization, and subjective performance of an exoscope system compared to the microscope in cochlear implantation (CI) and translabyrinthine resection of vestibular schwannomas (VS).

This prospective qualitative study was performed at a tertiary referral center. Ergonomics were evaluated subjectively with questionnaires in addition to the Rapid Upper Limb Assessment Tool (RULA), which was used as a quantitative measure of ergonomic risk. Performance and visualization parameters were assessed at specific surgical milestones in comparing the exoscope to the microscope.

Ergonomically, exoscopic surgery led to less straining in both subjective (p < 0.001) and objective (p < 0.001) measures. Visualization in terms of expansiveness, visual clarity, and depth was superior at each surgical milestone in VS (exoscope n = 7; microscope n = 5) and most of the CI milestones (exoscope n = 24; microscope n = 22). CI surgeries were completed faster with the exoscope (p = 0.007).

The 3D-exoscope afforded clear ergonomic advantages as compared with the microscope in so far as to reduce strains and potentially long-term risks to surgeons. Additional advantages over the traditional surgical microscope included improvement in the field of view and visual clarity, with no effect on time to completion. Further advancements in exoscope technology will ease the adaptation of this innovative device in cochlear implant and translabyrinthe surgeries.