High-Definition 4K-Three-Dimensional Exoscope in Spinal Surgery: A New Era of Visualization in Microsurgery?

Author(s): Stefano Peron, Angelo Rusconi, Andrea Cividini, Marco Sicuri, Paolo Roccucci, Roberto Stefini

In the last years, the use of exoscopes in microsurgery has been proposed due to their greater and sharper intraoperative magnification. The main advantages of these devices, in addition to the high definition and magnification, are better comfort for surgeons and the possibility to involve the entire surgical team in the procedure. The aim of this study is to demonstrate feasibility and advantages of using the exoscope in spinal surgery. The exoscope is equipped with an external orbital camera on an articulated arm, controlled manually or via a foot control. The position of the exoscope, including the camera and the two monitors (55-inch and 31-inch), in the operating room (OR) depends on the spinal procedure. The surgical procedures performed with the exoscope were assessed by each surgeon immediately afterwards through a questionnaire with nine questions on the characteristics of the instrumentation. From September 2019 to March 2021, we performed 99 spinal surgical procedures using the exoscope instead of the operating microscope. In all but one evaluation question, the score obtained was equal to or greater than 4, in a range from 1 (very dissatisfied) to 5 (very satisfied). In no case was it necessary to shift from the exoscope to the microscope due to limitations or difficulties in viewing anatomical details. The exoscope is an effective tool in spinal surgery and is able to replace the microscope in microsurgical procedures, offering very high-quality and detailed anatomical visualization, allowing surgeons to operate in a comfortable position.