4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

Abstract

Background In previous reports on experiences with an exoscope, this new technology was not found to be applicable for transsphenoidal pituitary surgery. As a specialized center for pituitary surgery, we were using a 4K 3D video microscope (Orbeye, Olympus) to evaluate the system for its use in transsphenoidal pituitary surgery in comparison to conventional microscopy. Method We report on 296 cases performed with the Orbeye at a single institution. An observational study was conducted with standardized subjective evaluation by the surgeons after each procedure. An objective measurement was added to compare the exoscopic and microscopic methods, involving surgery time and the initial postoperative remission rate in matched cohorts. Results The patients presented with a wide range of pathologies. No serious events or minor complications occurred based on the usage of the 4K 3D exoscope. There was no need for switching back to the microscope in any of the cases. Compared to our microsurgically operated collective, there was no significant difference regarding duration of surgery, complications, or extent of resection. The surgeons rated the Orbeye beneficial in regard to instrument size, positioning, surgeon’s ergonomics, learning curve, image resolution, and high magnification. Conclusions The Orbeye exoscope presents with optical and digital zoom options as well as a 4K image resolution and 3D visualization resulting in better depth perception and flexibility in comparison to the microscope. Split screen mode offers the complementary benefit of the endoscope which may increase the possibilities of lateral view but has to be evaluated in comparison to endoscopic transsphenoidal procedures in the next step.

The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery

“…The development of surgical magnification and neurosurgery progressed on separate paths until the 1960s, when the merging of these two innovations led to the rapid growth of cerebral surgery [ 98 , 99 , 100 , 101 ]. From that time, intraoperative technological advances improved, and the OM and endoscope allowed complete resection of glioma and other intraventricular and pituitary tumors, neurovascular and spine diseases, under magnification with good lighting and through minimally invasive approaches [ 12 , 15 , 16 , 45 , 47 , 57 , 58 , 60 , 95 , 102 , 103 ].…”

“…Furthermore, these devices still have usage limitations due to their high cost and to the impossibility, at the moment, to use 5-ALA fluorescence for tumor resection. A major advantage of the exoscope is the shared 3D view for all participants in the procedure [ 28 , 67 , 95 ]. The possibility to look at the same time in the same monitor allows more than one surgeon to operate and improves efficiency by sharing information with all surgical staff.…”

“…One of the characteristics ascribed to exoscopes is that they are superior to a conventional OM in terms of ergonomic features both in brain and spine surgery [ 37 , 39 , 49 , 52 , 67 , 69 , 90 , 91 , 92 , 94 , 95 , 96 , 97 , 111 , 112 , 113 , 114 , 115 ], as the ergonomic handling and the ease of intraoperative positioning of the device were found to be beneficial. Second, 3D monitors lead to an improved involvement of the co-surgeon and the scrub nurse during the procedure, and although some authors were satisfied with the high-resolution 3D digital images during surgery [ 52 , 60 , 68 , 73 ], others were not satisfied with the visual quality.…”

“…Overall postoperative surgical complications with permanent motor deficit range from 0% to 8% [ 30 , 39 , 44 , 55 ]. Rotermund et al [ 95 ] reported the largest series of patients underwent transsphenoidal surgery for pituitary adenoma (239 patients), reporting that no serious episodes or minor complications occurred based on the usage of the exoscope, as well as no significant differences regarding the duration of surgery, complications or extent of resection compared to conventional microscopy. Chen et al [ 73 ] reported a total of 81 patients received tumor resection through the retrosigmoid approach with either an exoscope (39 patients) or an OM (42 patients).…”

Experiences with a 3D4K Digital Exoscope System (ORBEYE) in a Wide Range of Neurosurgical Procedures

“…Furthermore, first authors report their experiences in cranial and pediatric surgeries 9,[11][12][13][14] .…”