Technical Aspects and Operative Nuances Using a High-Definition 3-Dimensional Exoscope for Cerebral Bypass Surgery

Abstract

BACKGROUND Cerebral bypass operation is a technically challenging operation that requires excellent surgical visibility and efficient ergonomics to minimize complications and maximize successful revascularization. Despite the operative microscope's utilization for the past two generations, there remains a need for continued improvement in operative visualization and surgical ergonomics. OBJECTIVE To report the positives and negatives of our initial experience using a novel 4 K high-definition (4K-HD) 3-dimensional (3D) exoscope (EX) for cranial bypass surgery. METHODS A retrospective review over 6 mo was performed of all patients who have undergone cerebral bypass surgery at a single institution using the 4K-HD 3D EX. Advantages and disadvantages of the EX and clinical outcome of the patients were assessed. RESULTS A total of 5 patients underwent cerebral EC-IC bypass surgery with no EX-related complications and successful revascularization. The lightweight design of the EX allowed for easy instrument maneuverability as well as uncomplicated surgical set up in the operating room. The assistance of the cosurgeon was significantly more efficient compared to that of the operating microscope. The large monitor allowed for an immersive, collaborative, and valuable educational surgical experience. CONCLUSION Using the EX for cerebral bypass surgery, with 3D ultra-high-definition optics, enhancements of ergonomics, and improved training, we believe that the 3D 4K-HD EX may represent the next generation of operative scopes in microneurosurgery.

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

“…While no neurovascular surgeries were performed in our study, other studies have shown those procedures feasible for exoscopic surgery as well [11]. Apart from the use in neurosurgery, ENT surgeons have reported success and high satisfaction [1,14].…”

Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma

“…[17] Several skull-base neurosurgeons performing intranasal endoscopic surgery have demonstrated that lack of stereopsis does not prevent from achieving satisfactory surgical outcomes. [20] Notwithstanding, the 3D exoscope is promising innovative equipment, which has just been evaluated in the cranial and spinal procedure in the last 2 years, [21][22][23][24][25][26] clinical data comparing the 2D and 3D version in the setting of neurosurgical operation was lacking. In this study, we demonstrated that the 2D exoscope had a potentially comparable operational efficacy and safety, even with much less bleeding volume, as the operating microscope (OM) in large VS resection, which requires high handeye coordination.…”

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

“…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×.…”

“…The published literature reveals the increased interest in the application of exoscopic visualization in neurosurgery, with the vast majority of articles being published within the last two years [46,48,49,[51][52][53][54][55] . Thanks to literature contributions, it became possible to analyze the advantages and limitations of Vitom-3D.…”