Three-Dimensional Video Microscopy: Potential for Improved Ergonomics without Increased Operative Time?

Abstract

Three-dimensional (3D) video exoscopes are high-magnification stereo cameras that project onto monitors mounted in the operating room, viewable from different angles. Outside of plastic surgery, exoscopes have been shown to successfully improve the ergonomics of microsurgery, though sometimes with prolonged operating times. We compare a single surgeon's early experience performing free flap procedures from 2020 to 2021 using either a binocular microscope or a 3D video exoscope. Ten procedures were performed with the standard operating microscope and 8 procedures with the 3D exoscope. The microsurgeon, having minimal prior experience using an exoscope, reported less neck discomfort following the free flap procedures performed with the exoscope compared with the binocular surgical microscope. Total average operating time was comparable between the standard surgical microscope and the 3D exoscope (13.7 vs. 13.4 hours, p = 0.34). Our early experience using a 3D exoscope in place of a standard optical microscope demonstrated that the exoscope shows promise, offering an ergonomic alternative during microvascular reconstruction without increasing overall operating times. Future studies will compare free flap ischemia time between cases performed using the exoscope and the conventional binocular microscope. Medical Subject Headings authorized following words: free tissue flaps; operating rooms; ergonomics; microsurgery.

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“…Indeed, a preliminary study at our department did confirm this increase, mostly at the beginning of a learning curve. Next to intense training and routine of the surgeon and assisting staff, future technical developments of the operating microscope are likely to improve that issue ( 37 ).…”

“…Since its introduction in the 1960s, the operating microscope has evolved to a standard surgical instrument for the microsurgeon, somehow adapted to the discipline-specific requirements. However, a rigid angle of the lenses and the bifocal optics for three-dimensional vision limited to the surgeons looking through them, are reasons for ergonomic stress ( 37 ). Any digital projection and registration includes a two-dimensional vision, limiting stereotaxis and depth perception.…”