Comparison of Exoscopic and Microscopic Carotid Endarterectomy for Asymptomatic Carotid Stenosis: A Retrospective...

Exoscopic surgery provides superior ergonomics compared with conventional microscopic surgery. This retrospective study aimed to compare the clinical outcomes between exoscopic and conventional microscopic carotid endarterectomy for asymptomatic carotid stenosis. We retrospectively analyzed 23 consecutive microscopic carotid endarterectomy cases between March 2012 and November 2018 and 21 consecutive exoscopic carotid endarterectomy cases between December 2018 and August 2024. Patient demographics, lesion characteristics, operative parameters, and postoperative outcomes were compared between the groups. There were no significant differences in baseline characteristics between the microscopic and exoscopic carotid endarterectomy groups. The mean indocyanine green volume was significantly lower in the exoscopic (2 ± 1 mL) vs. microscopic carotid endarterectomy groups (6 ± 2 mL) (p < 0.0001). Similarly, the mean skin incision length was shorter in the exoscopic vs. microscopic group (74 ± 10 mm vs. 90 ± 18 cm, respectively; p = 0.0016). The microsurgical time was significantly shorter in the exoscopic vs. microscopic groups (157 ± 63 min vs. 219 ± 97 min, respectively; p = 0.04). There were no significant differences in safety or clinical outcomes between the 2 groups. Exoscopic carotid endarterectomy demonstrated safety and clinical outcomes comparable to those of microscopic carotid endarterectomy while offering certain benefits associated with advances in equipment and surgical technology.