Advances in Intraoperative Optics: A Brief Review of Current Exoscope Platforms

Abstract

BACKGROUND The advent of the operating microscope (OM) revolutionized the field of neurosurgery. It allowed surgeons to operate on and effectively treat diseases previously inaccessible with conventional eyesight because of magnification and illumination. Improvements in the essential methods of visualization and the quality of the optics have plateaued. Another main limitation of the OM remains its ergonomics because of the need of the surgeon and assistant to directly interface with the OM objective. Recently, exoscopes have been introduced to overcome some shortcomings of the conventional OM. OBJECTIVE To subjectively review the individual authors experience with the current exoscope platforms in an attempt to provide a resource to the neurosurgeon when considering imaging options. METHODS Experts with previous use of each individual platform were contacted and asked to contribute their experiences. RESULTS In total, 4 systems are discussed. They include the VITOM (Karl Storz, Tuttlingen, Germany), the Olympus ORBEYE (Olympus, Tokyo, Japan), the Synaptive Modus V (Synaptive Medical, Toronto, Canada), and the Zeiss KINEVO (Carl Zeiss AG, Oberkochen, Germany). CONCLUSION The advent of exoscopes has the potential to begin to allow surgeons to move beyond solely the microscope for intraoperative visualization while improving upon its ergonomic disadvantages.

Microneurosurgery in COVID-19–Positive Patients

“…A possible solution is the use of an exoscope, whose main advantages include greater magnification, wider focal distance, and better surgeon ergonomics, whereas the main disadvantage is its nonstereoscopic vision. 4,5 However, an exoscope is not available in all hospitals. How will patients undergo surgical procedures in these cases?…”

Does the method of visualization impact the performance of a new surgical task in novice subjects?

“…As a result, these systems have greatly evolved from the standardization of the operating microscope, to the validation of the endoscope, and to the recent addition of exoscopic visual systems including the robotically operated video optical telescopic system or ROVOT. The benefits of the ROVOT include maneuverability, ergonomics, and increased volume of view, while the inherent disadvantages include the lack of stereoscopy and 3D perception and proprioception . In this study, naïve subjects with no preconceived notions or biases were asked to complete surgical tasks using either the ROVOT or a microscope with the aim of assessing the relative impact of these critical visual cues on the performance of surgical tasks.…”

“…The ROVOT has optical advantages compared to the conventional surgical microscope, in particular a larger volume of view. An oft cited disadvantage of the ROVOT is the loss of stereoscopy and 3D perception . However, it is unclear if the learning and performance of surgical tasks is different when using one platform or another, particularly in unbiased trainees.…”

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.…”