Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity

Abstract

The development of the 3D exoscope has advanced intraoperative visualization by providing access to visual corridors that were previously difficult to obtain or maintain with traditional operating microscopes. Favorable ergonomics, maneuverability, and increased potential for instruction provide utility in a large range of procedures. Here, the authors demonstrate the exoscope system in a patient with progressive thoracolumbar junctional kyphosis with bony retropulsion of a T12–L1 fracture requiring a Schwab grade 5 osteotomy and fusion. The utilization of the exoscope provides visual access to the ventrolateral dura for the entire surgical team (surgeons, learners, and scrub nurse). The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21190

Implementation of a three-dimensional (3D) robotic digital microscope (AEOS) in spinal procedures

“…Giorgi et al demonstrated in a series of patients with thoracolumbar fractures with spinal cord compression a crucial improvement of the user-friendliness and visualization in lateral thoracolumbar procedures through the possibility to simply shift between microscopic and macroscopic vision without moving the exoscope and without blocking the deep surgical field 13 . Although we experienced some surgical time prolongation in the first two lateral cases, we quickly established an OR setup for all spine procedures based on the patient positioning, which diminished the setup conflicts and allowed a better positioning of the C-Arm.The exoscopic systems already demonstrated satisfying magnification and stereoscopic vision even in more challenging and extensive deformity correction procedures 14 . Still the major advantages, which we also observed in our study, are the improvement of 3D depth perception and magnification in minimally invasive procedures like the classical anterior cervical approach and the lateral thoracolumbar minithoracotomy or the retroperitoneal approach.…”