Performance of microvascular anastomosis with a new robotic visualization system: proof of concept

Abstract

Microvascular procedures require visual magnification of the surgical field, e.g. by a microscope. This can be accompanied by an unergonomic posture with musculoskeletal pain or long-term degenerative changes as the eye is bound to the ocular throughout the whole procedure. The presented study describes the advantages and drawbacks of a 3D exoscope camera system. The RoboticScope®-system (BHS Technologies®, Innsbruck, Austria) features a high-resolution 3D-camera that is placed over the surgical field and a head-mounted-display (HMD) that the camera pictures are transferred to. A motion sensor in the HMD allows for hands-free change of the exoscope position via head movements. For general evaluation of the system functions coronary artery anastomoses of ex-vivo pig hearts were performed. Second, the system was evaluated for anastomosis of a radial-forearm-free-flap in a clinical setting/in vivo. The system positioning was possible entirely hands-free using head movements. Camera control was intuitive; visualization of the operation site was adequate and independent from head or body position. Besides technical instructions of the providing company, there was no special surgical training of the surgeons or involved staff upfront performing the procedures necessary. An ergonomic assessment questionnaire showed a favorable ergonomic position in comparison to surgery with a microscope. The outcome of the operated patient was good. There were no intra- or postoperative complications. The exoscope facilitates a change of head and body position without losing focus of the operation site and an ergonomic working position. Repeated applications have to clarify if the system benefits in clinical routine.

Minimally invasive microsurgical decompression of the lumbar spine using a novel robotised digital microscope: A preliminary experience

“…have published their experience in three cases of cranial surgery, reporting remarkable advantages in workflow efficacy and comfort of the surgeon, with a quality of the digital imaging not inferior to that of traditional microscopes. Similar advantages with RS have been reported by Scaglioni et al 21. and Boehm et al 13.…”

“…Similar advantages with RS have been reported by Scaglioni et al 21. and Boehm et al 13. in head and neck surgery during microvascular anastomosis.…”

“…However, many surgeons still prefer using the OMs, mainly because of the stereoscopic vision, which is only partially provided by exoscopes in 3D modality 4–12 . Notably, some robotised systems linked to exoscopic, endoscopic or microscopic approaches have been developed to assist surgeons in visualisation and magnification of the surgical field 5,9,12,13 . The RoboticScope© (RS) (BHS Technologies, Innsbruck, Austria) device is a novel digital visualisation system composed of a robotic arm and two cameras, allowing for high‐quality stereoscopic imaging of the operative field.…”

Robotic-Assisted Microsurgery and Its Future in Plastic Surgery

“…Shortly after, our group successfully performed the world’s first microsurgical breast reconstructions employing deep inferior epigastric perforator (DIEP) and profunda artery perforator (PAP) flaps using this system. Additionally, other groups have successfully shown clinical usage by successfully performing an anastomosis [ 31 ], resection of intracranial tumors [ 32 ], or a tympanoplasty [ 33 ]. Acquisition costs for the system currently start at around €200,000 (as of May 2022) (reference: personal communication with BHS).…”

Cadaveric study of ergonomics and performance using a robotic exoscope with a head-mounted display in spine surgery

“…This allows the surgeon to adopt a more comfortable posture without changing the camera position. [14][15][16] Following our initial evaluation of a customized microsurgical training tool in conjunction with the RS, a cadaver study was planned as a follow-up study to evaluate the applicability of the RS for spinal decompression in a preclinical setting and to further evaluate the possibility of a smooth transition of the RS to the operating room (OR). [17] Material & Methods Participants 21 neurosurgeons, who had no previous experience with the HMD-based exoscope were invited to participate in this preclinical prospective study.…”