Exoscopic carotid endarterectomy using movable 4K 3D monitor: Technical note

Abstract

Background: Carotid endarterectomy (CEA) using conventional surgical microscope has been already established as golden standard. Recently, exoscope was introduced into the field of neurosurgery, and various merits of it have been reported. We report the experiences of exoscopic CEA using a movable 4K 3D monitor and discuss the feasibility of it. Methods: We report a consecutive series of 15 cases of exoscopic CEA for internal carotid artery (ICA) stenosis using a movable 4K 3D monitor between January 2020 and April 2021. We utilized ORBEYE as an exoscope system and a 31-inch movable 4K 3D monitor, which was installed in the Maquet Moduevo ceiling supply unit. Results: In all 15 cases, the procedures were accomplished only using the ORBEYE. There were no operative complications due to the use of the exoscope. In response to the operative site, the 4K 3D monitor was moved to face the operator. Even when the angle of the visual axis of the exoscope against the horizontal plane was small during the surgical manipulation in the distal portion of ICA, the operator was able to maintain a comfortable posture. Conclusion: Using the movable 4K 3D monitor, exoscopic CEA can be performed ergonomically. The operator can manipulate the distal portion of the ICA or proximal portion of the common carotid artery in a comfortable posture and face the monitor by adjusting its position.

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

“…[ 11 ] However, when using ORBEYE for the midline suboccipital approach, the operator can perform stable manipulations in a comfortable posture from the rostral end of the patient with slight head-down position, regardless of the operative site and visual axis. In addition, as we previously indicated,[ 9 , 17 , 22 , 25 ] even when the angle of the operative visual axis is approximately horizon, we could also maintain ergonomically comfortable posture and perform stably surgical manipulation.…”

“…[ 9 , 17 , 21 , 22 ] In our previous reports, we have noted that stable and comfortable microsurgery can be performed with ORBEYE regardless of the operative visual axis, because it is not necessary for the operator to sit along the visual axis of the exoscope. [ 9 , 17 , 22 , 25 ] In particular, ORBEYE facilitates ergonomic microsurgery when the angle of the operative visual axis is set to overhang. [ 17 ]…”

The Usefulness of Surgical Titanium Microclips for Mucosal Repair in the Frontal Sinus Using ORBEYE: A Technical Note

“…15,16) Then, we have previously reported that the ORBEYE is ergonomically superior to a microscope. [17][18][19][20][21][22] In the present case, using ORBEYE, we set the angle of the operative visual axis approximately horizontally and manipulated it for a comfortable posture during the mucosal repair. Thus, while performing the mucosal repair using conventional microscopy is possible, we believe ORBEYE may offer a highly convenient and efficient approach.…”