Clinical implementation of a 3D4K-exoscope (Orbeye) in microneurosurgery

Abstract

Exoscopic surgery promises alleviation of physical strain, improved intraoperative visualization and facilitation of the clinical workflow. In this prospective observational study, we investigate the clinical usability of a novel 3D4K-exoscope in routine neurosurgical interventions. Questionnaires on the use of the exoscope were carried out. Exemplary cases were additionally video-documented. All participating neurosurgeons (n = 10) received initial device training. Changing to a conventional microscope was possible at all times. A linear mixed model was used to analyse the impact of time on the switchover rate. For further analysis, we dichotomized the surgeons in a frequent (n = 1) and an infrequent (n = 9) user group. A one-sample Wilcoxon signed rank test was used to evaluate, if the number of surgeries differed between the two groups. Thirty-nine operations were included. No intraoperative complications occurred. In 69.2% of the procedures, the surgeon switched to the conventional microscope. While during the first half of the study the conversion rate was 90%, it decreased to 52.6% in the second half (p = 0.003). The number of interventions between the frequent and the infrequent user group differed significantly (p = 0.007). Main reasons for switching to ocular-based surgery were impaired hand–eye coordination and poor depth perception. The exoscope investigated in this study can be easily integrated in established neurosurgical workflows. Surgical ergonomics improved compared to standard microsurgical setups. Excellent image quality and precise control of the camera added to overall user satisfaction. For experienced surgeons, the incentive to switch from ocular-based to exoscopic surgery greatly varies.

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 ,…”

“…The use of the exoscope has been largely reported with a variety of different exoscope models used also in spinal surgery [ 5 , 7 , 15 , 26 , 29 , 41 , 71 , 89 ]. Ariffin et al [ 15 ] submitted an interesting series of minor to major surgical spine procedures in 69 patients using the exoscope, reporting only four cases (5.8%) of dural tear as surgical complications and no postoperative neurological deficits.…”

“…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.…”

Midline suboccipital approach to a vertebral artery–posterior inferior cerebellar artery aneurysm from the rostral end of the patient using ORBEYE

“…[ 23 ] However, from the operator’s perspective, microsurgery using an exoscope can be performed comfortably only from the rostral end, regardless of the operative site and visual axis. [ 9 , 10 , 16 , 17 , 21 , 22 , 26 ]…”

“…The ORBEYE (Olympus, Tokyo, Japan), which was the first to have 4K HD clarity concurrently with 3D visualization, provides high magnification function that can range from 1.1 to 25.8 times and high zooming ratio of 1:12 times (6 times through optical zooming and 2 times through digital zooming). [ 4 , 21 ] VITOM 3D, which is controlled through the IMAGE1 PILOT mounted on a rotation socket and articulation stand, can be switched an endoscope. [ 4 ] The Modus V offers voice-activated control, advanced robotic navigation integration, and cortical tractography.…”