Lessons Learned Using a High-Definition 3-Dimensional Exoscope for Spinal Surgery

Kwan, Kevin; Schneider, Júlia; Du, Victor; Falting, Lukas; Boockvar, John A.; Oren, Jonathan H.; Levine, Mitchell; Langer, David

doi:10.1093/ons/opy196

Cited by 97 publications

(97 citation statements)

References 13 publications

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“…High-definition (HD) 3D exoscope systems have been utilized in spinal surgeries with comparable results. 5 , 6 We have found that the use of an exoscope to be far more beneficial compared to a traditional microscope in this instance. The model we have utilized is the Modus V (Synaptive Medical, Toronto, Canada).…”

mentioning

confidence: 83%

Utility of a high-definition 3D digital exoscope for spinal surgery during the COVID-19 pandemic

et al. 2020

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mentioning

confidence: 83%

Utility of a high-definition 3D digital exoscope for spinal surgery during the COVID-19 pandemic

et al. 2020

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“…AR will also be an important addition when exoscopes are used for spine procedures. 42 Apart from AR displays on monitors, 31 an alternative to HUDor HMD-based AR might be projection systems offering direct augmentation by spatial AR projecting images directly onto the physical object surface without the need to carry or wear any additional display device. 33 Systems providing such an augmentation in the open space would increase the surgeon comfort compared with wearing heavy HMDs for longer procedures and would improve sharing and collaboration during a procedure; however up to now, such systems are not yet available.…”

Section: Smentioning

confidence: 99%

Spine Surgery Supported by Augmented Reality

Carl

Bopp

Saß

et al. 2020

Global Spine Journal

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Study Design: A prospective, case-based, observational study. Objectives: To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. Methods: In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. Results: AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably. Conclusions: Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.

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“…It took about nine years to further evolve the 2D visualization and introduce the first 3D exoscopic visualization system [39,40] . In the following years, the 3D exoscope has been used to perform various technical more demanding neurosurgical procedures, even in pediatric cases, including treatment of cerebrovascular disorders (i.e., aneurysm clipping and bypass surgery), degenerative spinal disorders, and resection of cranial and spinal tumors [41][42][43][44][45][46][47][48][49][50] . VITOM®-3D (Video Telescopic Operating Microscope, Karl Storz GmbH & Co. KG, Tuttlingen, Germany), provides a 3D visualization in ultra-high definition (4K) quality, with a focal length of 20-50 mm and magnification ranges from 8× to 30×.…”

Section: Exoscope In Neurosurgerymentioning

confidence: 99%

“…• Need for reposition and refocusing when surgical exposure changed from extradural to intradural Kwan et al [47] 2019 3D Barbagallo et al [44] 2019 3D…”

Section: Spinal Meningioma Surgerymentioning

confidence: 99%

The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

d’Avella¹,

Sacco²,

Somma³

et al. 2020

Mini-invasive Surg

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The favorable outcome generally associated with spinal meningioma surgery is the result of the continuing refinement of the surgical technique, the use of intraoperative neuromonitoring, and a better understanding of the tumor biological behavior. Among all the technological advancements, visualization tools are the keys to any successful surgical procedure. The operating microscope is the gold standard in all neurosurgical procedures. In recent years, high-definition exoscope systems have entered the field of neurosurgery, as another tool in the armamentarium of the contemporary neurosurgeon. After initial experiences and technical improvements, the exoscope has proven to be best suited for spinal procedures. This study aims to briefly review the exoscope journey in neurosurgery, with a special focus on spinal meningioma surgery. Benefits and limitations are analyzed and an illustrative case is reported. Spinal meningiomas removal under exoscope visualization has proven to be feasible, efficient, and safe. Indication for the use of the exoscope greatly depends on meningioma size, consistency, relationship to surrounding neurovascular structures, and the surgeon's experience. Switching to the operating microscope, if deemed safer, should always be considered.

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Lessons Learned Using a High-Definition 3-Dimensional Exoscope for Spinal Surgery

Cited by 97 publications

References 13 publications

Utility of a high-definition 3D digital exoscope for spinal surgery during the COVID-19 pandemic

Utility of a high-definition 3D digital exoscope for spinal surgery during the COVID-19 pandemic

Spine Surgery Supported by Augmented Reality

The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

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