Exoscopic Cerebrovascular Neurosurgery

Doron, Omer; Langer, David; Ellis, Jason A.

doi:10.1016/j.nec.2022.05.008

Cited by 8 publications

(11 citation statements)

References 18 publications

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“…In the literature on exoscopic neurosurgery, several advantages over the OM are frequently mentioned, referring to a more ergonomic and comfortable position for the surgeon, a greater range of motion, and consequently a better and larger field of view with improved illumination, image quality and visualization, and magnification of structures [ 11 , 21 ]. These advantages may be particularly applicable to pediatric deep-seated and posterior fossa tumors, which often force positioning of the patient and require wide illumination, greater depth of field and longer surgical times, similar to complex procedures such as those requiring retrosigmoid approaches [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Exoscopic microneurosurgery in pediatric brain tumors: an ideal tool for complex and peculiar anatomo-topographic scenarios?

Trezza,

de Laurentis,

Carrabba

et al. 2023

Childs Nerv Syst

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Purpose Since its introduction in the 1950s, the microsurgical paradigm has revolutionized neurosurgery. New technologies have been introduced over the years trying to overcome limits of the classical operating microscope. The recently developed 3D exoscopes represent a potential new paradigm for micro-neurosurgery. We analyzed our own experience with a 4 K-3D exoscope in a series of pediatric brain tumors to verify its advantages and limitations in comparison to the operating microscope and in light of the literature. Methods Twenty-five pediatric patients with brain tumors underwent surgery at our Institute; the population has been analyzed and described. A score to evaluate the exoscopes and compare it to the operating microscope was considered and postoperatively applied to each single case. Results The exoscope appears to be at least comparable to the operating microscope (OM) in all analyzed aspects. In the case of deep-seated or fourth ventricle tumors, the exoscope seems to be superior to the microscope. A surgeon-dependent learning curve is necessary for neurosurgeons to be confident with the exoscope. Conclusion Exoscopes appear to be as safe and effective as operating microscopes in pediatric neuro-oncological surgery. They have some advantages that make them superior to microscopes, particularly regarding surgeon ergonomics and fatigue, visual field qualities, and higher choice of intraoperative viewing angles.

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Section: Discussionmentioning

confidence: 99%

Exoscopic microneurosurgery in pediatric brain tumors: an ideal tool for complex and peculiar anatomo-topographic scenarios?

Trezza,

de Laurentis,

Carrabba

et al. 2023

Childs Nerv Syst

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“…These procedures frequently require extended periods of surgical intervention, during which patients are subjected to prolonged periods of immobility. Such extended surgical durations not only predispose patients to significant fluctuations in body temperature but also require maintaining a fixed position for extended periods 1,2 . This immobility, in turn, exerts sustained pressure on specific areas of the skin, particularly those overlying bony prominences, leading to localized damage.…”

Section: Introductionmentioning

confidence: 99%

“…Such extended surgical durations not only predispose patients to significant fluctuations in body temperature but also require maintaining a fixed position for extended periods. 1,2 This immobility, in turn, exerts sustained pressure on specific areas of the skin, particularly those overlying bony prominences, leading to localized damage. The cumulative effect of these factors significantly heightens the risk of developing pressure ulcers during the surgical process, presenting a notable challenge in the perioperative management of neurosurgical patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the efficacy of standardized pressure ulcer management protocols in the prevention of pressure injuries among patients undergoing neurosurgical procedures

Zhang,

Li,

et al. 2024

International Wound Journal

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Pressure injuries are a significant concern for patients undergoing neurosurgical procedures due to prolonged immobility and the complexity of care. This study evaluates the efficacy of standardized pressure ulcer management protocols in preventing pressure injuries and enhancing patient care in a neurosurgical context. A comprehensive retrospective analysis was conducted at a single institution from December 2020 to December 2023, comparing 50 patients who received standardized pressure ulcer management (intervention group) with 50 patients who received conventional care (control group). The study assessed the incidence of pressure ulcers, patient comfort levels using the Kolcaba Comfort Scale and sleep quality using the Richards‐Campbell Sleep Questionnaire (RCSQ). Statistical analysis was performed using SPSS software, version 27.0, applying t‐tests and chi‐square tests as appropriate. The intervention group exhibited a significantly lower incidence of pressure ulcers at all measured time points post‐surgery compared to the control group. Patient comfort levels in the intervention group were consistently higher across psychological, environmental, physiological and socio‐cultural domains. Sleep quality metrics, including sleep depth, latency to sleep onset and overall sleep quality, were significantly improved in the intervention group. The implementation of standardized pressure ulcer management protocols in neurosurgical care significantly reduces the incidence of pressure injuries, enhances patient comfort and improves sleep quality. These findings highlight the importance of adopting structured care protocols to improve postoperative outcomes and patient well‐being in neurosurgical settings.

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“…[10][11][12] Several articles have reported that the exoscope is a safe alternative and superior to OM in terms of ergonomic features for skull base surgery, and cervical and lumbar spine surgery. [13][14][15][16][17][18][19][20][21] Lin et al systematically studied the advantages and disadvantages of using microscopes and exoscopes in cervical spine microsurgery, including objective ergonomic measurements using rapid upper limb assessment (RULA). 22 However, systematic studies comparing exoscope with OM in terms of advantages and limitations including operative outcomes, image quality and illumination, and subjective (questionnaire) and objective (REBA) ergonomics for attending surgeons in lumbar surgeries are still missing.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have shown that the use of an exoscope involves ease of use, and depth of focus compared to OM 10–12 . Several articles have reported that the exoscope is a safe alternative and superior to OM in terms of ergonomic features for skull base surgery, and cervical and lumbar spine surgery 13–21 . Lin et al .…”

Section: Introductionmentioning

confidence: 99%

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

Lin

Chen

Lin

et al. 2023

Orthopaedic Surgery

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The risk of musculoskeletal injuries (MSIs) increases over years of practice which may lead to careerending 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.

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Exoscopic Cerebrovascular Neurosurgery

Cited by 8 publications

References 18 publications

Exoscopic microneurosurgery in pediatric brain tumors: an ideal tool for complex and peculiar anatomo-topographic scenarios?

Exoscopic microneurosurgery in pediatric brain tumors: an ideal tool for complex and peculiar anatomo-topographic scenarios?

Evaluating the efficacy of standardized pressure ulcer management protocols in the prevention of pressure injuries among patients undergoing neurosurgical procedures

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

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