Heads-up Surgery

Ridge, Sarah E.; Shetty, Kishore; Lee, Dong Hoon

doi:10.1016/j.otc.2020.09.024

Cited by 24 publications

(27 citation statements)

References 64 publications

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“…Our findings show that there were no significant differences between the two techniques for most of the variables analyzed, including the duration of surgery and the subjective measures of intraoperative quality concerning the visualization of key anatomic structures (Tables 2 and 3) The only significant difference between the two techniques was the rate of transient facial nerve palsy, which affected 10% (n = 4) of patients in the operating microscope group versus 29% (n = 9) in the exoscope group. The VITOM 3D exoscope presents several important theoretical advantages over conventional instruments (operating microscopes, endoscopes, and loupes), including high-resolution 3D visualization with excellent illumination, a higher degree of freedom of movement, and excellent ergonomics with reduced fatigue [13]. In addition to these advantages, one of the main benefits of this technology is the high-definition images displayed on an external monitor, allowing the entire surgical team to observe the procedure in detail, and providing an important learning opportunity for all staff members, particularly residents in training (Fig.…”

Section: Discussionmentioning

confidence: 99%

Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

Bartkowiak

Łuczewski

Chou

et al. 2021

Eur Arch Otorhinolaryngol

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Background High-definition, three-dimensional (3D) exoscopes are being used to perform a growing number of head and neck surgeries. However, the use of the 3D exoscope in parotid gland surgery has not been previously described. Our initial experience with the VITOM 3D exoscope in the surgical treatment of parotid gland tumors is detailed here. Methods We made a prospective study of patients with benign parotid gland tumors indicated for surgical resection. Between January and December 2018, patients were randomly assigned to undergo surgery assisted with the VITOM 3D system (n = 31) or an operating microscope (n = 40). Visualization quality (greater auricular nerve, digastric muscle, tragal pointer), operating time, conversion rates, and surgical outcomes were compared. Results A total of 71 patients underwent superficial (n = 18) or total parotidectomy (n = 53). No exoscope-related complications were observed. Five patients undergoing exoscope-guided deep lobe surgery required intraoperative conversion to a microscope. No differences were observed in the subjective quality of intraoperative visualization of key anatomical structures. However, a significantly higher percentage of patients in the exoscope group developed transient facial nerve paralysis (n = 9; 29% vs. n = 4, 10%). Conclusions These findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. However, the high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

Bartkowiak

Łuczewski

Chou

et al. 2021

Eur Arch Otorhinolaryngol

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“…Another dubious drawback of the use of exoscopes, which happens to be the other side of the improved ergonomics, is the uncoupling of the surgeon's line of vision from the surgical approach orientation ( 39 ), while some authors consider this to be a problem ( 33 ), particularly for more experienced surgeons with more consolidated motor schemes ( 27 ) this happens to be the very reason for the improved ergonomics and the possibility to achieve very steep angles of vision ( 27 ). In the authors' experience, while being unable to rely on core, shoulder, and neck proprioception to help in surgical orientation is a striking difference to the OM, this is overcome quickly.…”

Section: Methodsmentioning

confidence: 99%

Exoscope as a Teaching Tool: A Narrative Review of the Literature

et al. 2022

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Recently, the emergence of the three-dimensional (3D) exoscope has proven to be a viable alternative to the operative microscope (OM) as a novel workhorse of microneurosurgical procedures. Through its current iteration, the 3D exoscope has been demonstrated to be at least equivalent to the operative microscope in terms of surgical outcomes in many settings. With its superior ergonomics and simplicity of use, the 3D exoscope has been shown in multiple studies to be a powerful visualizing tool during surgical procedures. Moreover, the exoscopic systems, through their current iterations and by means of a high-resolution 3D monitor and 3D glasses, have allowed all participants present in the operative room to attain an unprecedented level of intraoperative visualization of anatomical structures and surgical maneuvers which are traditionally available only to the first operator. Although long-term data are still lacking regarding its future as a replacement of the OM, the 3D exoscope has revealed itself as an intense subject of discussion in neurosurgery regarding its implication for surgical education, especially for residents and junior neurosurgeons. This article is a review of the current state of the literature on the role of the exoscope in surgical education, underlining its strength as a learning tool and its potential future implications in terms of surgical education.

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“…Real-time postural feedback devices and ergonomic coaching paradigms merit further investigation, as well as the implementation of microbreaks during long stretches of operative time. Finally, a growing body of evidence suggests that exoscopes may marry the benefits of microscopy and endoscopy, providing optimal image quality and magnification, a flatter learning curve, and perhaps superior ergonomics (34)(35)(36)(37)(38)(39). These three optical modalities have heretofore not been directly and objectively compared within any surgical specialty, including otolaryngology.…”

Section: Discussionmentioning

confidence: 99%

Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope

et al. 2023

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Objective: The comparative postural health of surgeons performing endoscopic and microscopic otologic surgeries has been a topic of active debate, with many nascent or anecdotal reports suggesting the latter encourages suboptimal ergonomics. Using inertial body sensors to measure joint angles, this study sought to objectively evaluate and compare the ergonomics of surgeons during endoscopic and microscopic otologic surgeries. Study Design: Prospective pilot trial. Setting: Large, multicenter, academic hospital system. Performed 21 otologic operations (10 endoscopic and 11 microscopic) in November 2020 and January 2021. All attendings were fellowship trained in otology/neurotology. Subjects: Eight otolaryngologists (four attendings and four residents) performing 21 otologic surgeries (11 microscopic and 10 endoscopic). Intervention: Approach to otologic surgery: endoscope or microscope. Main Outcome Measures: Surgeons' neck and back angles while wearing ergonomic sensors affixed to either side of each major joint, mental and physical burdens and pain after each surgery (via modified NASA Task Load Index).Results: Residents' necks (9.54°microscopic vs. −4.79°endoscopic, p = 0.04) and backs (16.48°microscopic vs. 3.66°endoscopic, p = 0.01) were significantly more flexed when performing microscopic surgery than when performing endoscopic surgery, although attending neck and back flexion were comparable during microscopic and endoscopic surgeries. Attendings reported significantly higher pain levels after operating microscopically than after operating endoscopically (0.13 vs. 2.76, p = 0.01). Conclusions: Residents were found to operate with significantly higher risk back and neck postures (as defined by the validated ergonomic tool, Rapid Entire Body Assessment) when operating microscopically. Attendings reported significantly higher levels of pain after operating microscopically versus endoscopically, suggesting that the suboptimal microscopic postures adopted earlier in training may pose an indelible risk later in a surgeon's career.

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Heads-up Surgery

Cited by 24 publications

References 64 publications

Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

Exoscope as a Teaching Tool: A Narrative Review of the Literature

Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope

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