The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation

Abstract

The development of the three-dimensional (3D) exoscope is a marvel of technological innovation in modern surgical practice. While its predecessor, the operating microscope (OM), has long been the gold-standard surgical visualization modality, its particular limitations in terms of accessibility and ergonomic demand have led to the development of a more sophisticated, 3D model. Specifically, the 3D exoscope allows for an enhanced image quality of the surgical field, while also being more ergonomically favorable. Moreover, this device's ability to handle delicate microsensitve procedures, along with its alleviation of surgeon fatigue, indicates great potential for neurosurgical application. For this narrative review, the authors queried PubMed database using the keyword "exoscope" to identify relevant studies involving the specialty of neurosurgery that were published in English language full text. The search yielded full-text English language-related articles regarding neurosurgical exoscope, its applications and limitations. The 3D exoscope uniquely allows for enhanced surgeon comfort and superior imaging of the patient's real-time anatomy. However, the OM was described to having a slight image favorability with fusion and decompression surgery. Cost analysis is highlighted for its potential disparity. 3D exoscopes will potentially be incorporated with intelligent carriers and robotic surgical systems. Ultimately, with further studies highlighting its use, the 3D exoscope is expected to continue to imprint its status as one of the most efficient technological visualization tools in the future of neurosurgical practice.

Exoscope for Upper Extremity Peripheral Nerve Surgery: Revision Carpal Tunnel Release With Epineurolysis and Hypothenar Fat Flap

“…The exoscope (extracorporeal operating microscope) system is a video camera mounted onto a stereotactic arm that is positioned outside the body and then projected onto the surgical field. The image is projected for the surgeon onto a video/computer monitor in real time [ 1 , 2 ]. The ORBEYE (Olympus, Tokyo, Japan) is the first exoscope with 4K high-definition clarity with concurrent three-dimensional (3D) visualization [ 2 , 3 ].…”

“…The image is projected for the surgeon onto a video/computer monitor in real time [ 1 , 2 ]. The ORBEYE (Olympus, Tokyo, Japan) is the first exoscope with 4K high-definition clarity with concurrent three-dimensional (3D) visualization [ 2 , 3 ]. The optical zoom ranges from 1.1 to 25.8x magnification, the focal lengths range from 220 to 550 mm, and the fields of view range from 7.5 to 171 mm [ 3 ].…”

Midline suboccipital approach to a vertebral artery–posterior inferior cerebellar artery aneurysm from the rostral end of the patient using ORBEYE

“…The ORBEYE (Olympus, Tokyo, Japan), which was the first to have 4K HD clarity concurrently with 3D visualization, provides high magnification function that can range from 1.1 to 25.8 times and high zooming ratio of 1:12 times (6 times through optical zooming and 2 times through digital zooming). [ 4 , 21 ] VITOM 3D, which is controlled through the IMAGE1 PILOT mounted on a rotation socket and articulation stand, can be switched an endoscope. [ 4 ] The Modus V offers voice-activated control, advanced robotic navigation integration, and cortical tractography.…”

“…[ 4 , 21 ] VITOM 3D, which is controlled through the IMAGE1 PILOT mounted on a rotation socket and articulation stand, can be switched an endoscope. [ 4 ] The Modus V offers voice-activated control, advanced robotic navigation integration, and cortical tractography. [ 4 ] The KINEVO acts as a combined microscope and exoscope and contains PointLock function that can be very useful in visualizing a larger area inside a cavity by simulating a keyhole movement.…”

“…[ 4 ] The Modus V offers voice-activated control, advanced robotic navigation integration, and cortical tractography. [ 4 ] The KINEVO acts as a combined microscope and exoscope and contains PointLock function that can be very useful in visualizing a larger area inside a cavity by simulating a keyhole movement. [ 4 , 18 ] Aeos exoscope has a six-joint robotic arm which is controlled by a foot pedal and also provides the point lock function of pivoting around a locked focus.…”