Taming the exoscope: a one-year prospective laboratory training study

Abstract

Purpose Digital 3D exoscopes have been recently introduced as an alternative to a surgical microscope in microneurosurgery. We designed a laboratory training program to facilitate and measure the transition from microscope to exoscope. Our aim was to observe the effect of a one-year active training on microsurgical skills with the exoscope by repeating a standardized test task at several time points during the training program. Methods Two board-certified neurosurgeons with no previous exoscope experience performed the same test tasks in February, July, and November during a 12-month period. In between the test tasks, both participants worked with the exoscope in the laboratory and assisted during clinical surgeries on daily basis. Each of the test segments consisted of repeating the same task 10 times during one week. Altogether, 60 test tasks were performed, 30 each. The test task consisted of dissecting and harvesting the ulnar and radial arteries of the second segment of a chicken wing using an exoscope (Aesculap AEOS). Each dissection was recorded on video and analyzed by two independent evaluators. We measured the time required to complete the task as well as several metrics for evaluating the manual skills of the dissection and handling of the exoscope system. Result There was a clear reduction in dissection time between the first and the last session, mean 34 min (SD 5.96) vs. 26 min (SD 8.69), respectively. At the end of the training, both neurosurgeons used the exoscope more efficiently utilizing more available options of the device. There was correlation between the dissection time and several of the factors we used for evaluating the work flow: staying in focus, zoom control, reduction of unnecessary movements or repetitive manual motions, manipulation technique of the vessel under dissection, handling of the instruments, and using them for multiple dissection purposes (stretching, cutting, and splitting). Conclusion Continuous, dedicated long-term training program is effective for microsurgical skill development when switching from a microscope to an exoscope. With practice, the micromotor movements become more efficient and the use of microinstruments more versatile.

Assessing the Training in Neurosurgery with the Implementation of VITOM-3D Exoscope: Learning Curve on Experimental Model in Neurosurgical Practice

“…As the participants gained confidence, superfluous movements decreased, and they embraced more efficient microsurgical techniques. The study further highlighted variables affecting dissection time, encompassing focus-related issues, unnecessary movements, and zooming behavior, thereby emphasizing the profound impact of skills and experience in exoscope-assisted surgery [16].…”

Even short-term training improves the skills of novice exoscope users: a prospective laboratory experiment

“…Previous studies on learning mechanisms in exoscope-assisted microsurgery are scarce [ 8 , 10 ]. Few studies have reported relatively quick adaptation to using the exoscope in a laboratory setting [ 8 ].…”

“…Since the exoscope availability is limited in most neurosurgical units, it is relevant to know whether short-term exoscope training develops the skills needed for performing exoscope-assisted surgery. Furthermore, it is relevant to assess how previous microsurgical experience affect the adaptation process [ 10 ].…”