3D Exoscope System in Neurosurgery—Comparison of a Standard Operating Microscope With a New 3D Exoscope in the Cadaver Lab

Abstract

BACKGROUND For decades, the operating microscope has been the “gold standard” visualization device in neurosurgery. The development of endoscopy revolutionized different surgical disciplines, whereas in neurosurgery, the endoscope is commonly used as an additional device more than as single visualization tool. Invention of a 3D exoscope system opens new possibilities in visualization and ergonomics in neurosurgery. OBJECTIVE To assess the prototype of a 3D exoscope (3D exoscope, year of manufacture 2015, FA Aesculap, Tüttlingen, Germany) as neurosurgical visualization device in comparison to a standard operating microscope. METHODS A pterional approach was performed in 3 ETOH-fixed specimens (6 sides). A standard operating microscope was compared to a 3D exoscope prototype. Dimensions like visual field, magnification, illumination, ergonomics, depth effect, and 3D impression were compared. RESULTS In all approaches, the structures of interest could be clearly visualized with both devices. Magnification showed similar results. The exoscope had more magnification potential, whereas the visual quality got worse in higher magnification levels. The illumination showed better results in the microscope. Surgeons felt more comfortable with the 3D exoscope, concerning ergonomic considerations. Depth effect and 3D impression showed similar results. None of the surgeons felt uncomfortable using the exoscope. CONCLUSION The operating microscope is the gold standard visualization tool in neurosurgery because of its illumination, stereoscopy, and magnification. Nevertheless, it causes ergonomic problems. The prototype of a 3D exoscope showed comparable features in visual field, stereoscopic impression, and magnification, with a clear benefit concerning the ergonomic possibilities.

Volume of Surgical Freedom: The Most Applicable Anatomical Measurement for Surgical Assessment and 3-Dimensional Modeling

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Multidisciplinary approach to the craniovertebral junction. Historical insights, current and future perspectives in the neurosurgical and otorhinolaryngological alliance

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The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

“…The published literature reveals the increased interest in the application of exoscopic visualization in neurosurgery, with the vast majority of articles being published within the last two years [46,48,49,[51][52][53][54][55] . Thanks to literature contributions, it became possible to analyze the advantages and limitations of Vitom-3D.…”