Technical Assessment of Microvascular Decompression for Trigeminal Neuralgia Using a 3-Dimensional Exoscope: A Case Series

Microsurgical Resection of Meningiomas Using a 4K Three-Dimensional Exoscope: A Descriptive Observational Study

Background Prior to using the exoscope, we speculated that it represented an intermediate tool between a loupe and a microscope and had concerns about its visibility of deep, fine structures. Objective To evaluate the depths of meningioma for which the exoscope was suitable, and to clarify its disadvantages in meningioma resection. Methods Findings of consecutive meningioma surgeries using a 4K three-dimensional (3D) exoscope over a one-year period were evaluated for visibility of the surgical field, comfort of the surgeon's arm posture, the surgeon's head orientation, and perception of the image delay, accounting for the depth of the tumor. Results Seven meningiomas were resected using a 4K 3D exoscope (three superficial, three intermediate, and one deep). The exoscope allowed the surgeon to observe deeply located fine structures as clearly as with a conventional microscope and to operate more comfortably on meningiomas of all depths with arms flexed. On the contrary, the exoscope occasionally required the surgeon to operate with his head unnaturally turned to one side because of the immobility of its large monitor, despite the wide insertion availability of its camera from various directions to meningiomas located superficially or within the middle cranial fossa. No time delays between the surgeon's manipulations and the 3D images were perceived in all meningioma surgeries. Conclusions The 4K 3D exoscope was suitable for operations on all depths of meningiomas. The discrepancy between the surgeon's manipulation and gaze directions was its disadvantage. It is anticipated that further development of the 3D monitor will address this issue.

3D4K exoscope in epilepsy surgery: a seminal experience

BACKGROUND AND OBJECTIVES

To report the progressive introduction of the exoscope (EX) from surface lesionectomy to antero-mesial temporal lobectomy (AMTL) in an epilepsy surgery practice.

METHODS

We describe a population of ten consecutive patients undergoing EX surgery, with a minimum follow-up of 6 months, that was compared to a similar population of patients referred to operative microscopic surgery (OM).

RESULTS

All surgeries were performed with the use of EX or OM alone. Transient neurological complications for surgery in eloquent regions were recorded in one patient for each population. Nine and seven patients undergoing, respectively, EX and OM surgery resulted in Engel class Ia (90% vs. 70%). The mean duration of EX and OM surgery resulted in 265.5 and 237.9 min, respectively, with a mean of 308.3 and 253.3 min for AMTL cases, respectively.

CONCLUSIONS

This preliminary study revealed that ORBEYE EX can be safe and effective in different types of epilepsy surgeries. The transition from OM to EX is fast, even though it is slower for the more challenging mesial temporal structure removal. Ergonomic and operative team interaction is improved by the use of EX. Our data need to be confirmed by larger studies.

Beyond Magnification and Illumination: Ergonomics with a 3D Exoscope in Lumbar Spine Microsurgery to Reduce Musculoskeletal Injuries

OBJECTIVE

The risk of musculoskeletal injuries (MSIs) increases over years of practice which may lead to career-ending among surgeons. Exoscopes represent a new generation of imaging systems that help surgeons operate in a more comfortable posture. This article aimed to assess advantages and limitations, especially ergonomics with a 3D exoscope in lumbar spine microsurgery versus an operating microscope (OM) to reduce MSIs.

METHODS

From March 2018 to May 2020, 90 patients with lumbar disc herniation undergoing a single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) procedure were included. Forty-seven patients were operated with the assistance of the exoscope and 43 patients were operated with the assistance of the OM. Clinical data, magnification, and illumination were evaluated. In particular, the ergonomics of surgeons was evaluated by a questionnaire (subjective) and a rapid entire body assessment (REBA; objective).

RESULTS

The postoperative outcomes were reasonably well balanced between the two groups. The handling of the exoscope was comparable to that of the OM. The depth perception, image quality, and illumination of the exoscope were inferior to those of the OM in MIS-TLIF with long and deep approaches. The educational and training function of the exoscope was superior to that of the OM. Importantly, surgeons rated the ergonomics of the exoscope as very high on the questionnaire and the REBA to the OM (P = 0.017).

CONCLUSIONS

This study showed that the exoscope was a safe and effective alternative to the OM for assisting the MIS-TLIF procedure with the unique advantage of ergonomics to reduce musculoskeletal injuries.