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

Abstract

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.

High‐definition three‐dimensional exoscope for head and neck reconstruction: Prospective analysis of 27 consecutive patients

“…No comparative studies were able to clarify the differences between these two technologies at this time. Two pre‐clinical studies have tried to compare the OE and the OM in performing microvascular anastomoses 21,22 . These studies demonstrated the non‐inferiority of the OE, but no clear differences and recommendations were drawn.…”

3D Exoscopes in Microsurgery: How 3D Exoscopes Reconfigure the Workflow of Assistant Surgeons and Nurses in the Operating Room

“…The conventional microscopes have, however, several limitations, including limited focal range, image quality, portability, and especially in terms of ergonomics [11,15]. Surgeons stand and operate in uncomfortable positions during surgery, because they need to fix their eyes to the eyepieces of the microscopes [13,15] (see Figure 1 (a)). Moreover, the surgeons use either a mouth switch or handgrips to constantly adjust the view of the microscopes [2].…”

“…It enables surgeons to perform surgeries in a heads-up position which eases their neck and back pain and all surgical members to easily follow a surgical procedure by watching a 3D screen. Most research has investigated the impact of the 3D exoscopes on a primary surgeon's performance in terms of its technical (e.g., image quality, lighting, magnification) and surgical aspects (e.g., optics, ergonomics, maneuverability of instruments) [11,13,15]. Beyond the benefits to surgeons, this state-of-the-art technology is also expected to improve communication between surgical team members during surgery, because people in an operating room (OR) can easily follow a surgical procedure and have the same view with the primary surgeon by watching a 3D screen [3,8].…”

The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation

“…The exoscope system is composed of a scope positioned outside of the body cavity such that a high-definition (HD) view of the surgical field is projected onto a two-dimensional (2D) or 3D high-resolution monitor. Recent efforts to preserve stereopsis as well led to the development of the 3D exoscope system [ 4 ]. The gradual application of the 3D exoscope system in a multitude of neurosurgical procedures such as cranial and spinal surgeries has suggested that it is a safe and effective alternative to the OM [ 3 , 5 , 6 ].…”