Neurosurgical applications of the exoscope: from in vitro studies to real-life surgical use in selective dorsal rhizotomy - 15/09/24
Highlights |
• | The microscope’s magnification abilities have long been essential in neurosurgery, allowing interventions otherwise impossible. However, its ergonomic challenges prompt the exploration of alternatives like the exoscope, which offers similar magnification with better ergonomics. |
• | The visual field provided by the exoscope is larger compared to the microscope, specifically measuring 54.10 cm2 for the microscope and 81.18 cm2 for the exoscope at 30 cm with 2.7× zoom. |
• | We found no differences in image sharpness at any zoom level between the microscope and the exoscope. |
• | In terms of ergonomics, the exoscope is superior to the microscope. Using spine UpSurgeOn® models, we observed that to view the most lateral angles of the field of vision with the microscope, the upper body needs to be inclined approximately 20 degrees relative to the neutral axis. In contrast, with the exoscope, it is possible to maintain the upper body straight at 0 degrees relative to the neutral axis. |
• | Selective Dorsal Rhizotomy represents a surgical domain where the exoscope proves particularly relevant: allowing exclusive tilting of the camera and enabling the maintenance of an upright posture with a direct gaze towards the anterior screen, proves to be the best choice in terms of ergonomics, as well as the breadth of the visual field, allowing access to even the least accessible angles. Easier interaction with operating room staff is another advantage of the exoscope over the microscope. |
Abstract |
Background |
The microscope has been the gold standard in neurosurgical practice due to its ability to magnify anatomical structures. However, it has limitations, including restricted visual fields and ergonomic challenges that can lead to surgeon fatigue and musculoskeletal issues. The exoscope is an emerging technology that may address these limitations by offering comparable magnification with improved ergonomics.
Methods |
This study compares the traditional microscope (KINEVO 900) with a 3D digital exoscope (Aeos Digital Microscope) in visual field width, image sharpness, and ergonomic impact. Visual field assessments were conducted using millimeter paper at a fixed distance, while image sharpness was evaluated using graph paper with pins at different depths. Ergonomic evaluation involved simulating surgical positions using a spine anatomical model. The practical applicability was tested during Selective Dorsal Rhizotomy (SDR) procedures, comparing the surgeon's experience with both devices over 20 consecutive cases.
Results |
The exoscope provided a larger visual field (81.18 cm2) compared to the microscope's (54.10 cm2). Image sharpness was similar for both devices across various depths and zoom levels. Ergonomically, the exoscope allowed the surgeon to maintain a neutral posture while visualizing extreme angles, unlike the microscope, which required significant upper body movement. In SDR procedures, the exoscope improved surgeon comfort and interaction with the operating team, despite an initial learning curve.
Conclusions |
The exoscope presents notable advantages in terms of visual field and ergonomics. The exoscope’s ability to facilitate better posture and team communication without compromising image quality makes it an addition to neurosurgical practice, as in SDR.
Le texte complet de cet article est disponible en PDF.Keywords : Exoscope 3D, Selective dorsal rhizotomy (SDR), Neurosurgery, Ergonomics, Surgical field, Microscope
Plan
Vol 70 - N° 6
Article 101586- novembre 2024 Retour au numéro
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