Monitor-based exoscopic 3D4k neurosurgical interventions: a two-phase prospective-randomized clinical evaluation of a novel hybrid device

Roethe, Anna L.; Landgraf, Philipp; Schröder, Torsten; Misch, Martin; Vajkoczy, Peter; Picht, Thomas

doi:10.1007/s00701-020-04361-2

Cited by 33 publications

(36 citation statements)

References 28 publications

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“…Ergonomics were perceived as favourable in comparison to the conventional microscope. Enabling an upright head position in 86% of the exoscopic operation time in our study was superior to a lately described upright head posture of 52% during ocular-based cranial surgeries [14].…”

Section: Discussioncontrasting

confidence: 79%

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

et al. 2021

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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. 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 analyse 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. Thirty-nine 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. 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.

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Section: Discussioncontrasting

confidence: 79%

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

et al. 2021

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Section: Discussioncontrasting

confidence: 79%

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

Rösler

Georgiev

Roethe

et al. 2021

Preprint

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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.

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“…Like the operating microscope (and in contrast to endoscopes), the 3D exoscope is an external device with dual image sensors for 3D visualization. In recent years, the 3D exoscope has become an established tool for neurosurgical visualization [1][2][3][4][5]. Although operating microscopes provide comparable illumination and magnification, visualization of the surgical field is limited to the surgeon and assistant, leaving the other members of the surgical team with only a limited view of the depth of the surgical field and important anatomical details.…”

Section: Introductionmentioning

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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Monitor-based exoscopic 3D4k neurosurgical interventions: a two-phase prospective-randomized clinical evaluation of a novel hybrid device

Cited by 33 publications

References 28 publications

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

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

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

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

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