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Sanuki T, Takemoto N, Sumiya S, Iwasaki S. Preliminary Experience with 3-Dimensional Exoscope-Assisted Laryngoplasty. Laryngoscope 2024; 134:1813-1819. [PMID: 37800700 DOI: 10.1002/lary.31086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Laryngoplasty requires the manipulation of the vocal folds, which are not visible during the operation. The widespread use of this technique is limited by the need for adequate knowledge of anatomy, the small surgical field, and the high level of skill required for the procedure. An exoscope has been developed to provide a stereoscopic view similar to that of a microscope while using the same compact endoscopic tool. This study aimed to determine whether the three-dimensional (3D) exoscopic surgical technique could be applied to laryngoplasty and explore its possibility to ultimately replace the current approach. METHODS This was a retrospective case series analysis, which included 28 patients with hoarseness who underwent surgery with (Exoscope; n = 12) or without (Macrosurgery; n = 16) a 3D exoscope between July 2018 and February 2021. The feasibility of performing all surgical steps with the 3D exoscope was evaluated. The Exoscope and Macrosurgery groups were compared for surgical time, vocal function outcomes, and complications. Questionnaires were completed by medical staff regarding the usefulness of medical education. RESULTS No intraoperative or postoperative complications occurred in either procedure. The operative time was similar in both groups. The vocal function outcomes were also comparable between the groups. Questionnaires revealed that the exoscope was useful in terms of sharing information on surgical procedures and anatomy, as well as functioning as an educational tool. CONCLUSION While this was a preliminary study, our results indicated that the exclusive use of the 3D exoscope was feasible for open approaches. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1813-1819, 2024.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoki Takemoto
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shogo Sumiya
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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2
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Tu NC, Doerfer K, Costeloe A, Sioshansi PC, Babu S. Educational Benefit of the Three-Dimensional Exoscope Versus Operating Microscope in Otologic Surgery. Otol Neurotol 2024; 45:150-153. [PMID: 38082465 DOI: 10.1097/mao.0000000000004066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To compare observation of otologic surgery using a traditional operating microscope (OM) and a three-dimensional exoscope. STUDY DESIGN Prospective, nonrandomized, noncontrolled study. SETTING Tertiary care center. METHODS Senior medical students and otolaryngology trainees observing otologic surgery performed with OM and exoscope were asked to complete a questionnaire comparing the two experiences. The key variables were image clarity, depth perception, observer's level of motion sickness during the surgery, the participant's understanding of middle ear anatomy, and their overall preference between OM and exoscope. RESULTS Twenty-two observers participated in the study. Subjective clarity of the image was significantly better with the exoscope compared with the OM (9.7 ± 0.6 versus 6.9 ± 1.7, p = 0.0004) as well as the depth perception (9.25 ± 0.87 versus 5 ± 2.69, p = 0.0007). Observers subjectively had an improved understanding of middle ear anatomy after observing an exoscopic surgery, but not a microscopic surgery. All but one observer preferred the exoscope. CONCLUSION The three-dimensional exoscope may be a valuable educational tool for teaching trainees otologic surgery. More objective studies are needed in the future to assess the degree of improvement.
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Affiliation(s)
- Nathan C Tu
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York
| | - Karl Doerfer
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anya Costeloe
- Department of Otolaryngology-Head and Neck Surgery, Ascension Macomb-Oakland, Warren, Michigan
| | - Pedrom C Sioshansi
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Seilesh Babu
- Michigan Ear Institute, Farmington Hills, Michigan
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Conway RM, Fan CJ, Choi JS, Babu K, Mallany HP, Babu SC. Exoscope-Assisted Stapedotomy: Evaluation of Safety and Efficacy. Otol Neurotol 2023; 44:978-982. [PMID: 37939357 DOI: 10.1097/mao.0000000000004042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Evaluate the safety and efficacy of exoscope-assisted stapedotomy. STUDY DESIGN Retrospective chart review. SETTING Tertiary care neurotology clinic. PATIENTS Adult patients with otosclerosis undergoing stapedotomy. INTERVENTIONS Primary stapedotomy. MAIN OUTCOME MEASURES Evaluation of audiologic outcomes, including pure-tone average, bone-conduction thresholds, word recognition score, and air-bone gap. Complications, need for scutum removal, and length of surgery were also evaluated. RESULTS A total of 47 patients were identified, and 24 patients underwent surgery with the microscope and 22 with the exoscope. There were significant improvements in pure-tone average, mean bone-conduction thresholds, and air-bone gap for both groups. There was no difference in preoperative or postoperative audiologic status for either group. There was no difference in rates of dysgeusia, chorda tympani nerve damage, dizziness, or facial paresis in either group. CONCLUSIONS This study indicates similar audiologic outcomes, complication profiles, and visualization when comparing exoscopic and microscopic stapedotomy. Demonstrated here, exoscopic stapedotomy can be safely performed in a transcanal manner.
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Affiliation(s)
| | | | | | - Kavan Babu
- Michigan State University, East Lansing, Michigan
| | - Hugh P Mallany
- University of New England School of Osteopathic Medicine, Biddeford, Maine
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Hashikata H, Maki Y, Futamura G, Yoshimoto N, Goto M, Hayashi H, Nishida N, Iwasaki K, Toda H. Functionality and Usability of the Exoscope in Microvascular Decompression for Hemifacial Spasm and Trigeminal Neuralgia. World Neurosurg 2023; 179:e539-e548. [PMID: 37683924 DOI: 10.1016/j.wneu.2023.08.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Studies on the functionality and usability of the exoscope in neurosurgical procedures against surgical microscopes (SMs) are limited. This study aimed to examine the functionality and usability of the exoscope during microvascular decompression (MVD) surgery. METHODS Seven neurosurgeons evaluated the usefulness of a 4 K, 3-dimension digital exoscope in MVD by answering a questionnaire. The questionnaire inquired about the functionality and usability of the exoscope by utilizing a visual analog scale (VAS; 1-10). A score of 5 on VAS was equivalent to the corresponding quality of the SM. The learning effect of the exoscope was evaluated using mean VAS scores in the first and last 3 cases for each neurosurgeon. RESULTS The functionality of the exoscope in MVD was superior to that in SM (P < 0.001). In the last 3 surgeries, the mean VAS scores of the exoscope were excellent in terms of ease of arm handling, exchange of surgical instruments, ease of surgical procedure, and intraoperative physical stress. The mean VAS scores of the exoscope in intraoperative asthenopia were significantly higher than those of the SM (P < 0.001). No statistical significance was found in operation time, discharge outcome, and 1-year post-surgery outcome between MVD performed using the exoscope and SM. CONCLUSIONS Neurosurgeons may experience reduced stress levels during MVD when using the exoscope. As the outcome of MVD using the exoscope did not demonstrate a statistical difference compared with MVD using the SM, the exoscope may prove to be a useful tool for performing MVD.
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Affiliation(s)
- Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan.
| | - Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone, Japan; Department of Rehabilitation, Hikari Hospital, Otsu, Japan
| | - Gen Futamura
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Masanori Goto
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Namiko Nishida
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
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Karinen E, Iso-Mustajärvi M, Dietz A. The Feasibility of the Three-Dimensional Footswitch-Operated Robotic Arm Exoscope for Cochlear Implant Surgery. Otol Neurotol 2023; 44:786-790. [PMID: 37464472 PMCID: PMC10453336 DOI: 10.1097/mao.0000000000003952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To compare the three-dimensional (3D) footswitch-operated robotic arm exoscope with the operating microscope (OM) in cochlear implant surgery. STUDY DESIGN Matched case-control study. PATIENTS Cochlear implantation was performed with the exoscope on unselected patients with normal temporal anatomy. The control group that underwent cochlear implantation with the OM was case matched with respect to age, anatomy, surgical technique, and type of anesthesia. INTERVENTIONS Cochlear implantation performed with the 3D exoscope. MAIN OUTCOME MEASURES Surgical time, occupation of the operation theater, surgical results, and user experience evaluated by a questionnaire. RESULTS Eleven patients (13 ears) were successfully operated on with the exoscope. In the exoscope group, we observed one minor intraoperative complication, where the middle dura was exposed during mastoidectomy. Although no clear preference was evident for either device in the overall rating, the subdomain rating revealed that the exoscope's image quality was deemed inferior, especially at higher magnifications where pixelation became noticeable. The exoscope received higher scores for usability, particularly excelling in terms of surgeon's ergonomic and comfortability. There was a statistically significant difference in mean surgical time, 146 and 129 min for the exoscope and OM group, respectively. CONCLUSIONS Cochlear implant surgery was found to be feasible with a 3D exoscope. However, there is a learning curve to overcome regarding handling and the different quality of the image. The exoscope provides better ergonomics for the surgeon.
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Affiliation(s)
- Eerika Karinen
- Department of Otorhinolaryngology, Satasairaala Hospital, Pori, Finland
| | | | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Otorhinolaryngology, University of Eastern Finland, Kuopio, Finland
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Chiang H, Ledbetter L, Kaylie DM. Systematic Review of Otologic and Neurotologic Surgery Using the 3-dimensional Exoscope. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e024. [PMID: 38516578 PMCID: PMC10950122 DOI: 10.1097/ono.0000000000000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/12/2022] [Indexed: 03/23/2024]
Abstract
Objective The 3D exoscope is an emerging technology that has been met with success in neurosurgery and is now increasingly used in otologic and neurotologic surgery. There is currently no consensus on its safety, efficiency, and utility, compared to the traditional microscope for these procedures. This systematic review aims to evaluate the use of the 3-dimensional (3D) exoscope for otologic and neurotologic surgery. Databases Reviewed MEDLINE/PubMed, Web of Science, Scopus, and EMBASE. Methods A systematic search of the databases was conducted for otologic and neurotologic surgery using the 3D exoscope. English language papers with no limit on the date of publication were considered. Inclusion criteria: full articles studying otologic or neurotologic/skull base surgery using exoscopes. Exclusion criteria: non-otologic surgery and non-neurotologic/skull base surgery, exclusive use of the traditional microscope, editorials, video reports, and letters. Two authors independently reviewed papers for inclusion; discrepancies were settled by consensus. Extracted variables included: number of patients, types of surgical procedures, operative and postoperative complications, setup and operative time, and visualization and ergonomic rating. Results Six articles containing 128 surgical cases (103 exoscopic and 25 microscopic) were analyzed. Of the exoscopic cases, 21% were surgeries for chronic ear disease, 5% were cochlear implants, and 74% were lateral skull base procedures encompassing a wide variety of approaches. Conclusion Based on preliminary studies, the exoscope appears to be comparable in safety, visualization, and efficiency compared to the operating microscope, with the potential for increased comfort and ease of use.
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Affiliation(s)
- Harry Chiang
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Leila Ledbetter
- Medical Center Library and Archives, Duke University School of Medicine, Durham, North Carolina
| | - David M. Kaylie
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
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Miura I, Kohara K, Kawamata T. An Experience With an Exoscope System (ORBEYE) for Surgery for Tarsal Tunnel Syndrome: A Case Report. Cureus 2022; 14:e28045. [PMID: 36120253 PMCID: PMC9474269 DOI: 10.7759/cureus.28045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/05/2022] Open
Abstract
Surgery for peripheral entrapment neuropathy aims to decompress the affected nerve and optimize the visualization of anatomical details during surgery. This paper describes our experience using the ORBEYE exoscope (Olympus) during surgery for tarsal tunnel syndrome (TTS). The patient was a 70-year-old male with complaints of bilateral pain and numbness on the plantar surface of the bilateral soles and medial halves of both lower limbs. He was diagnosed with idiopathic TTS with the American Orthopedic Foot and Ankle Score (AOFAS) of 20/100. Surgery for the right foot was performed under local anesthesia with the patient’s body in the lateral position. All procedures were performed using the ORBEYE exoscope view. The posterior tibial artery (PTA) was transposed, and the flexor retinaculum was reconstructed between the PTA and posterior tibial nerve. Indocyanine green (ICG) video angiography confirmed the absence of PTA flow disturbance. One month after the first operation, left foot surgery was performed. Three months later, the AOFAS had improved from 20/100 to 50/100. The ORBEYE exoscope is useful in TTS treatment and represents a feasible and comfortable technique for entrapment neuropathy surgery. In addition, ICG capability is an effective tool for confirming blood flow in PTA after transposition.
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Hu K. Nursing Education of Lateral Oblique Complications of Neurosurgery under Microscope. SCANNING 2022; 2022:2158181. [PMID: 36051255 PMCID: PMC9410997 DOI: 10.1155/2022/2158181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
In order to solve the problem of nursing education of lateral oblique complications, a nursing education solution of lateral oblique complications of neurosurgery under the microscope was proposed. The method used subjective evaluation and objective evaluation to systematically evaluate the basic training module. In subjective evaluation, the authenticity score of surgical simulator was 3.65 ± 0.01, the realism score of surgical instruments was 3.81 ± 0.01, the realism score of tactile sense was 3.75 ± 0.01, the operating environment score was 3.60 ± 0.01, and the overall effect score was 3.63 ± 0.01. The difficulty score of the whole training was 3.15 ± 0.01. In the aspect of objective evaluation, the entropy method was used to process the data of training track, training angle, training time, trigger times, success times, failure times, and other indicators of 24 trainers collected, and the experiment verified the nursing education of lateral oblique complications of neurosurgery under the microscope.
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Affiliation(s)
- Kecui Hu
- School of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui 230012, China
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9
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Calloni T, Roumy LG, Cinalli MA, Rocca A, Held A, Trezza A, Carrabba GG, Giussani CG. Exoscope as a Teaching Tool: A Narrative Review of the Literature. Front Surg 2022; 9:878293. [PMID: 35558390 PMCID: PMC9086489 DOI: 10.3389/fsurg.2022.878293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Recently, the emergence of the three-dimensional (3D) exoscope has proven to be a viable alternative to the operative microscope (OM) as a novel workhorse of microneurosurgical procedures. Through its current iteration, the 3D exoscope has been demonstrated to be at least equivalent to the operative microscope in terms of surgical outcomes in many settings. With its superior ergonomics and simplicity of use, the 3D exoscope has been shown in multiple studies to be a powerful visualizing tool during surgical procedures. Moreover, the exoscopic systems, through their current iterations and by means of a high-resolution 3D monitor and 3D glasses, have allowed all participants present in the operative room to attain an unprecedented level of intraoperative visualization of anatomical structures and surgical maneuvers which are traditionally available only to the first operator. Although long-term data are still lacking regarding its future as a replacement of the OM, the 3D exoscope has revealed itself as an intense subject of discussion in neurosurgery regarding its implication for surgical education, especially for residents and junior neurosurgeons. This article is a review of the current state of the literature on the role of the exoscope in surgical education, underlining its strength as a learning tool and its potential future implications in terms of surgical education.
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Affiliation(s)
- Tommaso Calloni
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Louis Georges Roumy
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Maria Allegra Cinalli
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Alessandra Rocca
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Andrea Held
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Andrea Trezza
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Giorgio Giovanni Carrabba
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Carlo Giorgio Giussani
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
- *Correspondence: Carlo Giorgio Giussani
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Tamura R, Kuranari Y, Katayama M. A Three-Surgeon–Six-Hand Operation Using a 4K-3D Exoscope for Neurological Surgery: A Case Report. Front Surg 2022; 9:866476. [PMID: 35360435 PMCID: PMC8961730 DOI: 10.3389/fsurg.2022.866476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/18/2022] [Indexed: 01/13/2023] Open
Abstract
Background Advances in digital imaging including evolving of 3-dimensional (3D) exoscope has allowed its use as an alternative to microscopes in neurosurgery. The exoscope can concede wide space around the operating table and patient. Here, we show a three-surgeon–six-hand operative approach using a 4K-3D exoscope. Practical advantages and disadvantages of this approach are discussed. Clinical Presentation A 58-year-old male was refered with a 60 mm diameter meningioma in the right frontal convexity. The tumor removal was done by an operator and two assistants with a scrub nurse while viewing images displayed on a 55-inch monitor with integrated 4K and 3D visualization technology retrieved by KINEVO®. Meaningful communication between the operator and two assistants allowed for simultaneous, and precise surgical procedures. Gross total removal was achieved without damaging the brain. Conclusion The ocular-free, openness of 4K-3D exoscope allows for a three-surgeon–six-handed operation, which leads to simultaneous surgical maneuvers by multiple hands, shorter operative time, flexible/intermittent brain retraction made by two assistants, and educational benefits owing to the surgical procedure being visually shared.
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Affiliation(s)
- Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Japan
- Department of Neurosurgery, Kawasaki Municipal Hospital, Kawasaki, Japan
- *Correspondence: Ryota Tamura
| | - Yuki Kuranari
- Department of Neurosurgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Makoto Katayama
- Department of Neurosurgery, Kawasaki Municipal Hospital, Kawasaki, Japan
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Rodriguez-Unda NA, Wu DS. Exoscope for Upper Extremity Peripheral Nerve Surgery: Revision Carpal Tunnel Release With Epineurolysis and Hypothenar Fat Flap. Cureus 2022; 14:e22539. [PMID: 35345755 PMCID: PMC8956492 DOI: 10.7759/cureus.22539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
The exoscope is a high-resolution three-dimensional external microscope that allows the surgeon to perform delicate dissection in multiple regions of the body. The exoscope was originally used for intracranial and spine surgery. In this article, we describe its novel use in upper extremity peripheral nerve decompression surgery after recurrent carpal tunnel syndrome. This surgery is typically performed under the microscope, which allows precise microsurgical dissection to distinguish scar tissue from healthy nerve fascicles. Our case report highlights a 70-year-old man with recurrent carpal tunnel syndrome who underwent revision carpal tunnel surgery with epineurolysis and hypothenar fat flap. The ergonomic benefits of using the exoscope for microsurgery are described, along with intraoperative photos. Adequate symptom resolution was achieved.
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Göttsche J, Piffko A, Pantel TF, Westphal M, Flitsch J, Ricklefs FL, Regelsberger J, Dührsen L. Experiences with a 3D4K digital exoscope system (ORBEYE) in a wide range of neurosurgical procedures. J Neurol Surg A Cent Eur Neurosurg 2022; 83:596-601. [PMID: 35144300 DOI: 10.1055/a-1768-4060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND STUDY AIMS Exoscopic 3D4K video systems (EX) have recently been introduced as an alternative to conventional operating microscopes (OM). However, experience in handling and setup remains scarce. This study evaluated the practicability of exoscopic surgery in a wide range of procedures. MATERIAL AND METHODS All EX operations performed between 08/2018 and 05/2020 were evaluated and compared to procedures using OM. A standardized questionnaire was used to evaluate surgeons' comfort, image quality (including fluorescence modes) and handling. RESULTS 513 EX operations were during the investigated period. EX was generally rated as a valuable surgical tool. In particular, the digital 5-aminolevulinic acid (5-ALA) fluorescence and the comfort level of posture during surgery were stated to be superior to OM (100 and 83%, respectively). CONCLUSION EX has been used for a significant number of neurosurgical procedures. While presuming that the technical methodology as such will not influence outcome of glioma surgery, proof of equipoise between different techniques expands the spectrum of surgical environments giving neurosurgeons a choice to work according to their preferred ergonomics.
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Affiliation(s)
- Jennifer Göttsche
- Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andras Piffko
- Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Fabian Pantel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Neurosurgery, Medical Center Hamburg-Eppendorf, hamburg, Germany
| | - Joerg Flitsch
- Pituitary Unit, Clinic of Neurosurgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Hamburg, Germany
| | - Franz Lennard Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Neurosurgical Dept., Diako Klinikum Flensburg, Flensburg, Germany
| | - L Dührsen
- Neurosurgery, UKE Hamburg Eppendorf, Hamburg, Germany
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Combined Exoscopic and Endoscopic Technique for Craniofacial Resection. Curr Oncol 2021; 28:3945-3958. [PMID: 34677254 PMCID: PMC8535086 DOI: 10.3390/curroncol28050336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.
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14
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Peron S, Paulli S, Stefini R. Case Report: High-Definition 4K-3D Exoscope for Removal of an Orbital Cavernous Hemangioma Using a Transpalpebral Approach. Front Surg 2021; 8:671423. [PMID: 34422890 PMCID: PMC8377276 DOI: 10.3389/fsurg.2021.671423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Cavernous hemangioma, also known as cavernous vascular malformation (CVM), is the most common primary lesion of the orbit in adults. The management of these lesions is challenging and is strongly dependent on their location, as well as the patient's symptoms and expectations. The trans-palpebral approach is currently used in surgery for orbital tumors, anterior skull base tumors, and even more, orbital reconstruction, because of its well-demonstrated esthetic advantages. Similarly, the use of magnification can be provided by surgical loupes, microscope, or more recently, endoscope, which is well-documented for its advantages in terms of minimal invasiveness and safety. In the last years, the use of exoscopes in microsurgery has been proposed due to their greater and sharper intraoperative magnification, but never for the removal of orbital tumors. Clinical Presentation: We describe a case of a 38-year-old woman with a right orbital intraconic CVM removed using an inferior transpalpebral approach performed under 4K-3-dimensional (4K-3D) exoscopic vision. Navigation and ultrasound were also used, with the former allowing better identification of the lesion within the orbit and the second overcoming the limitations of navigation, in terms of the retraction on the ocular globe before or just after periorbital incision. Conclusion: The use of a 4K-3D exoscope allowed us to perform the surgery safely, thanks to the high magnification and definition of anatomical details, with the surgeon operating in an upright, comfortable position. The CVM was completely removed with excellent results from both functional and esthetic points of view.
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Affiliation(s)
- Stefano Peron
- Department of Neurosurgery, Azienda Socio Sanitaria Territoriale (ASST) Ovest Milanese - Legnano Hospital, Milan, Italy
| | - Stefano Paulli
- Department of Maxillofacial Surgery, Azienda Socio Sanitaria Territoriale (ASST) Ovest Milanese - Legnano Hospital, Milan, Italy
| | - Roberto Stefini
- Department of Neurosurgery, Azienda Socio Sanitaria Territoriale (ASST) Ovest Milanese - Legnano Hospital, Milan, Italy
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Bartkowiak E, Łuczewski Ł, Chou JTT, Wierzbicka M. Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study. Eur Arch Otorhinolaryngol 2021; 279:1029-1034. [PMID: 34047839 PMCID: PMC8794892 DOI: 10.1007/s00405-021-06876-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/09/2021] [Indexed: 01/23/2023]
Abstract
Background High-definition, three-dimensional (3D) exoscopes are being used to perform a growing number of head and neck surgeries. However, the use of the 3D exoscope in parotid gland surgery has not been previously described. Our initial experience with the VITOM 3D exoscope in the surgical treatment of parotid gland tumors is detailed here. Methods We made a prospective study of patients with benign parotid gland tumors indicated for surgical resection. Between January and December 2018, patients were randomly assigned to undergo surgery assisted with the VITOM 3D system (n = 31) or an operating microscope (n = 40). Visualization quality (greater auricular nerve, digastric muscle, tragal pointer), operating time, conversion rates, and surgical outcomes were compared. Results A total of 71 patients underwent superficial (n = 18) or total parotidectomy (n = 53). No exoscope-related complications were observed. Five patients undergoing exoscope-guided deep lobe surgery required intraoperative conversion to a microscope. No differences were observed in the subjective quality of intraoperative visualization of key anatomical structures. However, a significantly higher percentage of patients in the exoscope group developed transient facial nerve paralysis (n = 9; 29% vs. n = 4, 10%). Conclusions These findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. However, the high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation.
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Affiliation(s)
- Ewelina Bartkowiak
- Department of Otolaryngology and Head and Neck Surgery, Poznań University of Medical Sciences, Poznan, Poland.
| | - Łukasz Łuczewski
- Department of Otolaryngology and Head and Neck Surgery, Poznań University of Medical Sciences, Poznan, Poland
| | - Jadzia Tin-Tsen Chou
- Department of Otolaryngology and Head and Neck Surgery, Poznań University of Medical Sciences, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Head and Neck Surgery, Poznań University of Medical Sciences, Poznan, Poland
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