A Single-Center Experience with the Olympus ORBEYE 4K-3D Exoscope for Microsurgery of Complex Cranial Cases: Technical Nuances and Learning Curve

Abstract

Background The introduction of exoscopes in neurosurgery has been welcomed due to their maneuverability, ergonomics, and low-profile frame. 3D devices have further enabled a better stereoscopic visualization. Reports on their application, albeit more and more frequent, are still at their beginning stages. We present our experience with the Olympus ORBEYE 4K-3D exoscope for major cranial procedures. The strengths and weaknesses of the exoscope are presented, and the nuances associated with the learning curve are illustrated. Methods Over 2 weeks, patients undergoing surgery for major cranial pathologies were offered to participate in this evaluation of the Olympus ORBEYE 4K-3D exoscope. Information on the use of the exoscope was collected to assess the features and struggles in the learning curve. A comparison with the operating microscope was made. Results Fourteen patients with different intracranial pathologies were operated on with the exoscope. No surgery-related complications occurred. The microsurgical part was performed with the exoscope in six cases. The exoscope was used for 72.9% (±37.5%) of the whole microsurgical time vs. 27.1% (±37.5%) microscope time (p = 0.02). Conclusion The Olympus ORBEYE 4K-3D exoscope represents a useful evolution of the operating microscope. It requires time to overcome potential difficulties, mostly related to previous motor schemes acquired with operating microscopes. Its features could represent the basis for a paradigm shift in microsurgery.

Exoscope as a Teaching Tool: A Narrative Review of the Literature

“…Another dubious drawback of the use of exoscopes, which happens to be the other side of the improved ergonomics, is the uncoupling of the surgeon's line of vision from the surgical approach orientation ( 39 ), while some authors consider this to be a problem ( 33 ), particularly for more experienced surgeons with more consolidated motor schemes ( 27 ) this happens to be the very reason for the improved ergonomics and the possibility to achieve very steep angles of vision ( 27 ). In the authors' experience, while being unable to rely on core, shoulder, and neck proprioception to help in surgical orientation is a striking difference to the OM, this is overcome quickly.…”

The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery

“…After the removal of duplicates, 108 articles were eligible for screening. A total of 86 articles met the selection criteria [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 13 , 15 , 16 , 19 , 21 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ,…”

“…To date, several exoscopic systems are available for neurosurgical use. VITOM ® (Karl Storz, Tuttlingen, Germany), ORBEYE™ (Olympus, Tokyo, Japan), Modus V™ (Synaptive Medical, Toronto, ON, Canada), Kinevo 900 (Carl Zeiss Meditec AG, Jena, Germany), BrainPath ® (Nico Corporation, Indianapolis, IN, US) and Aeos ® (Aesculap, Tüttlingen, Germany) are the most commonly used, with different technical, software and hardware characteristics, but with the same goal [ 7 , 15 , 26 , 27 , 28 , 29 , 30 ]. As the exoscope will probably open a new era in the field of new tools and techniques in neurosurgery, as the OM did in the 1960s, this review aims to investigate about the use of the exoscope in preclinical and clinical neurosurgical settings, the most common neurosurgical procedures performed with the exoscope, as well as the impact of exoscope on surgical outcome and workflow, reporting operative complications, surgical procedures switched from exoscope to OM, and advantages and disadvantages compared to the microscope.…”

Exoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a retrospective single-center study on 388 patients

“…An exoscope is a new high-de nition digital imaging system, which has recently been successfully implemented in different elds of neurosurgery such as neurovascular, tumor or peripheral nerve surgery and offers better maneuverability, ergonomics, and stereoscopic visualization in comparison to the standard microscope [7][8][9][10][11] . First experiences with the exoscopic 4K 3D video microscope (Orbeye, Olympus) for transsphenoidal surgery from our center have already been reported 12 .…”