Advancement of Surgical Visualization Methods: Comparison Study Between Traditional Microscopic Surgery and a Novel Robotic Optoelectronic Visualization Tool for Spinal Surgery.
BACKGROUND
The operating microscope (OM) has become instrumental in aiding surgeons during key microdissection with greater safety and detail. An exoscope offers similar detail with improved functionality and greater implications for live teaching and improved operating room flow.


METHODS
Eleven senior neurosurgery residents and fellows performed unilateral, single-level laminotomies on fresh cadavers using an OM and exoscope. Three attending spine surgeons blinded for the visualization technique used then reviewed and graded each decompression. Data points gathered included time of procedure, grading of decompression (1-5), and complications, including dural tear, nerve root injury, and pars fracture.


RESULTS
Operative times between the 2 systems were not significantly different (14.9 minutes OM vs. 15.6 minutes exoscope, P = 0.766). Despite high variability between evaluators in assessing complications and adequacy of decompression, there was no significant difference between either system. Postprocedural surveys indicated greater comfort with the exoscope, greater ease of use, and superior teaching potential for the exoscope over the standard OM.


CONCLUSIONS
In our simulated operating room model, an exoscope is a valid alternative to the standard OM that affords the surgeon greater comfort with greater teaching potential while maintaining many of the microscope's benefits.
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA. Electronic address: moisimd@aol.com.
Marc D
MD
Moisi
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Kimberly
K
Hoang
Seattle Science Foundation, Seattle, Washington, USA.
R Shane
RS
Tubbs
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
Jeni
J
Page
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany.
Christian
C
Fisahn
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
David
D
Paulson
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
Shiveindra
S
Jeyamohan
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
Johnny
J
Delashaw
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
David
D
Hanscom
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
Rod J
RJ
Oskouian
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
Jens
J
Chapman
D002102:Cadaver; D006801:Humans; D007796:Laminectomy / Q000379:methods / Q000639:trends; D018715:Microscopy, Video / Q000379:methods / Q000639:trends*; D008866:Microsurgery / Q000379:methods / Q000639:trends*; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends*; D065287:Robotic Surgical Procedures / Q000379:methods / Q000639:trends*; D016037:Single-Blind Method; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery*
BrightMatter Servo; Exoscope; Exoscopic; Laminotomy; Operating microscope; Robotic arm; Spinal decompression; Surgical visualization; Video microscope