title: Application of a Compact High-Definition Exoscope for Illumination and Magnification in High-Precision Surgical Procedures.
abstract: BACKGROUND
  The basic necessities for surgical procedures are illumination, exposure, and magnification. These have undergone transformation in par with technology. One of the recent developments is the compact magnifying exoscope system. In this report, we describe the application of this system for surgical operations and discuss its advantages and pitfalls.
  
  
  METHODS
  We used the ViTOM exoscope mounted on the mechanical holding arm. The following surgical procedures were conducted: lumbar and cervical spinal canal decompression (n = 5); laminotomy and removal of lumbar migrated disk herniations (n = 4); anterior cervical diskectomy and fusion (n = 1); removal of intraneural schwannomas (n = 2); removal of an acute cerebellar hemorrhage (n = 1); removal of a parafalcine atypical cerebral hematoma caused by a dural arteriovenous fistula (n = 1); and microsutures and anastomoses of a nerve (n = 1), an artery (n = 1), and veins (n = 2).
  
  
  RESULTS
  The exoscope offered excellent, magnified, and brilliantly illuminated high-definition images of the surgical field. All surgical operations were successfully completed. The main disadvantage was the adjustment and refocusing using the mechanical holding arm. The time required for the surgical operation under the exoscope was slightly longer than the times required for a similar procedure performed using an operating microscope.
  
  
  CONCLUSIONS
  The magnifying exoscope is an effective and nonbulky tool for surgical procedures. In visualization around the corners, the exoscope has better potential than a microscope. With technical and technologic modifications, the exoscope might become the next generation in illumination, visualization, exposure, and magnification for high-precision surgical procedures.
authors.affiliation: Division of Reconstructive Neurosurgery, Department of Neurosurgery, Justus Liebig University, Giessen, Germany. Electronic address: k_g_krishnan@hotmail.com.
authors.forename: Kartik G
authors.initials: KG
authors.lastname: Krishnan
authors.affiliation: Division of Reconstructive Neurosurgery, Department of Neurosurgery, Justus Liebig University, Giessen, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Schöller
authors.affiliation: Division of Reconstructive Neurosurgery, Department of Neurosurgery, Justus Liebig University, Giessen, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Uhl
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation; D002493:Central Nervous System Diseases / Q000601:surgery*; D002526:Cerebellar Diseases / Q000601:surgery; D004867:Equipment Design; D006406:Hematoma / Q000601:surgery; D006801:Humans; D008029:Lighting / Q000295:instrumentation*; D008866:Microsurgery / Q000295:instrumentation*; D055806:Microvessels / Q000601:surgery; D009442:Neurilemmoma / Q000601:surgery; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D061646:Operative Time; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery; D013523:Surgical Equipment; D013536:Suture Techniques / Q000295:instrumentation; D061351:Telescopes; D020424:Ulnar Neuropathies / Q000601:surgery; D014741:Video Recording / Q000295:instrumentation*
keywords: Exoscope; High-definition image transmission; High-precision surgery; Magnification; Surgical technology