Clinical implementation of a 3D4K-exoscope (Orbeye) in microneurosurgery

Abstract

Background Exoscopic surgery promises alleviation of physical strain, improved intraoperative visualization and facilitation of the clinical workflow. In this prospective observational study we investigate the clinical usability of a novel 3D4K-exoscope in routine neurosurgical interventions. Methods Questionnaires on the use of the exoscope were carried out. Exemplary cases were additionally video-documented. All participating neurosurgeons (n=10) received initial device training. Changing to a conventional microscope was possible at all times. A linear mixed model was used to analyze the impact of time on the switchover rate. For further analysis we dichotomized the surgeons in a frequent (n=1) and an infrequent (n=9) user group. A one-sample Wilcoxon signed rank test was used to evaluate, if the number of surgeries differed between the two groups. Results 39 operations were included. No intraoperative complications occurred. In 69.2% of the procedures, the surgeon switched to the conventional microscope. While during the first half of the study the conversion rate was 90%, it decreased to 52.6% in the second half ( p =0.003). The number of interventions between the frequent and the infrequent user group differed significantly ( p =0.007). Main reasons for switching to ocular-based surgery were impaired hand-eye coordination and poor depth perception. Conclusion The exoscope investigated in this study can be easily integrated in established neurosurgical workflows. Surgical ergonomics improved compared to standard microsurgical setups. Excellent image quality and precise control of the camera added to overall user satisfaction. For experienced surgeons, the incentive to switch from ocular-based to exoscopic surgery greatly varies.

Single-Center Experience Using a 3D4K Digital Operating Scope System for Aneurysm Surgery

“…Studies investigating the practicality of this new visualization technique are now mandatory. 4,6,9,10 We systematically investigated and analyzed our experience with a 3D4K exoscope for microsurgical aneurysm repair, still one of the most challenging procedures in neurosurgery.…”

“…Because of the number of technical components of the EX, it is difficult to fundamentally change this setting during an operation, so detailed planning of the surgical setup must be performed in advance to ensure a smooth procedure. 10 In summary, the EX proved to be a practicable alternative to conventional OM in aneurysm surgery without significant limitations. Owing to the equal surgical results, the EX in our department is accepted for vascular microsurgical cases and is an additional intraoperatively visualization tool which can be chosen by surgeons preference.…”

“…[4][5][6] Image quality, depth perception, and illumination of these new generation scopes, including 3-dimensional imaging, have been reported to be equivalent, or even superior, to conventional OMs. 4,[7][8][9][10][11] Furthermore, surgeon comfort, postural and especially for the eyes, is reported to be increased and, therefore, the system more physiological. 4,8,10,11 Moreover, neuronavigation systems and fluorescence modes are optional features which are integrated components in some of these exoscope devices.…”

“…4,[7][8][9][10][11] Furthermore, surgeon comfort, postural and especially for the eyes, is reported to be increased and, therefore, the system more physiological. 4,8,10,11 Moreover, neuronavigation systems and fluorescence modes are optional features which are integrated components in some of these exoscope devices.…”

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

“…In the field of microsurgical disciplines, some experiences with the new technology have already been shared. 4 5 6 7 However, these studies refer mainly to experiences with few or individual cases.…”