Application of a Compact High-Definition Exoscope for Illumination and Magnification in High-Precision Surgical Procedures

Krishnan, Kartik G.; Schöller, Karsten; Uhl, Eberhard

doi:10.1016/j.wneu.2016.09.037

Cited by 76 publications

(59 citation statements)

References 18 publications

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“…Current literature demonstrates promise in neurosurgery [14]. The Exoscope appears at least equivalent to the OM in terms of image quality, magnification, and illumination, and offers high-resolution, precise focusing, and a broad depth of field [19,20]. Indeed, the Exoscope may prove superior to the OM in terms of image quality when connected to an ultra-high-definition monitor, although these advanced technical modifications could arguably be attached to any conventional OM [21].…”

Section: Discussionmentioning

confidence: 99%

“…The Exoscope has the potential to be integrated with other novel technological advancements, such as; augmented reality enhanced microsurgery and robotic-assisted microsurgery, as robotic devices that are under development require the use of a microscope to facilitate clinical performance [23]. The lack of stereopsis is its main drawback of similar video telescope operating monitor (VITOM) devices such as the endoscopicassisted microsurgery, as reported in other microsurgical subspecialties [4,5,18,19,24]. This can be overcome by using more than one 4K sensors to provide a stereoscopic 3D image [25].…”

Section: Discussionmentioning

confidence: 99%

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The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial

et al. 2020

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Background The Exoscope is a novel high-definition digital camera system. There is limited evidence signifying the use of exoscopic devices in microsurgery. This trial objectively assesses the effects of the use of the Exoscope as an alternative to the standard operating microscope (OM) on the performance of experts in a simulated microvascular anastomosis.Methods Modus V Exoscope and OM were used by expert microsurgeons to perform standardized tasks. Hand-motion analyzer measured the total pathlength (TP), total movements (TM), total time (TT), and quality of end-product anastomosis. A clinical margin of TT was performed to prove non-inferiority. An expert performed consecutive microvascular anastomoses to provide the exoscopic learning curve until reached plateau in TT.Results Ten micro sutures and 10 anastomoses were performed. Analysis demonstrated statistically significant differences in performing micro sutures for TP, TM, and TT. There was statistical significance in TM and TT, however, marginal non-significant difference in TP regarding microvascular anastomoses performance. The intimal suture line analysis demonstrated no statistically significant differences. Non-inferiority results based on clinical inferiority margin (Δ) of TT=10 minutes demonstrated an absolute difference of 0.07 minutes between OM and Exoscope cohorts. A 51%, 58%, and 46% improvement or reduction was achieved in TT, TM, TP, respectively, during the exoscopic microvascular anastomosis learning curve.Conclusions This study demonstrated that experts’ Exoscope anastomoses appear non-inferior to the OM anastomoses. Exoscopic microvascular anastomosis was more time consuming but end-product (patency) in not clinically inferior. Experts’ “warm-up” learning curve is steep but swift and may prove to reach clinical equality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial

et al. 2020

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“…The first clinical series of patients undergoing surgery with the aim of the exoscope consisted of technically less demanding neurosurgical procedures for which it was felt that trial use of this device could not potentially affect surgical outcomes. That lack of 3D visualization was a concern to many surgeons and this drawback was mentioned frequently in preliminary studies [24,[35][36][37][38] . It took about nine years to further evolve the 2D visualization and introduce the first 3D exoscopic visualization system [39,40] .…”

Section: Exoscope In Neurosurgerymentioning

confidence: 99%

The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

d’Avella¹,

Sacco²,

Somma³

et al. 2020

Mini-invasive Surg

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The favorable outcome generally associated with spinal meningioma surgery is the result of the continuing refinement of the surgical technique, the use of intraoperative neuromonitoring, and a better understanding of the tumor biological behavior. Among all the technological advancements, visualization tools are the keys to any successful surgical procedure. The operating microscope is the gold standard in all neurosurgical procedures. In recent years, high-definition exoscope systems have entered the field of neurosurgery, as another tool in the armamentarium of the contemporary neurosurgeon. After initial experiences and technical improvements, the exoscope has proven to be best suited for spinal procedures. This study aims to briefly review the exoscope journey in neurosurgery, with a special focus on spinal meningioma surgery. Benefits and limitations are analyzed and an illustrative case is reported. Spinal meningiomas removal under exoscope visualization has proven to be feasible, efficient, and safe. Indication for the use of the exoscope greatly depends on meningioma size, consistency, relationship to surrounding neurovascular structures, and the surgeon's experience. Switching to the operating microscope, if deemed safer, should always be considered.

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“…The device has several new features with novel intraoperative applications. The ViTOM [5][6][7][8] is one of the older devices which attempted to bridge the gap between microscopic and endoscopic visualization. Newer microscope tools have been developed to enhance surgical visualization such as ORBEYE, a 4K three-dimensional (3D) microvideoscope 3D-Eye-Flex, BrightMatter Servo System (Synaptive Medical).…”

Section: Neurosurgical Visualizationmentioning

confidence: 99%

Mythri 1.0—Progress of an Indian Surgical Robot

Vazhayil

Voggu

Arumalla

et al. 2020

Indian Journal of Neurosurgery

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Neurosurgical procedures are performed using operating microscopes. The technology of most microscopes has not changed much over the past 60 years. The National Institute of Mental Health and Neurosciences and International Institute of Information Technology based at Bengaluru have embarked on joint collaboration for developing robot for neurosurgical applications. As a working prototype, robotic microscope Mythri 1.0 has been developed. An overview of the development process, working, and features of the device is presented in the article.

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Application of a Compact High-Definition Exoscope for Illumination and Magnification in High-Precision Surgical Procedures

Cited by 76 publications

References 18 publications

The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial

The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial

The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

Mythri 1.0—Progress of an Indian Surgical Robot

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