Study indicates benefits of switching from microscope to 3D exoscope in spine surgery

Researchers and neurosurgeons at the Medical University of South Carolina (MUSC; Charleston, USA) retrospectively compared […]

Researchers and neurosurgeons at the Medical University of South Carolina (MUSC; Charleston, USA) retrospectively compared the operative microscope to the 3D exoscope in a recent study of spine surgery procedures published in World Neurosurgery—and found potentially better outcomes for both surgeons and patients alike when using the latter.

MUSC’s Stephen Kalhorn, who was the principal investigator for the study, said the traditional operative microscope has its limitations as a surgical tool. With its more restricted positioning options, the operative microscope often sits too close to the surgical field, and surgeons find that they are prone to bumping their instruments into it throughout the procedure.

However, with an exoscope—which is commonly deployed within a variety of intracranial procedures, but has a somewhat underreported usage in spinal surgery—a high-definition, 3D digital imaging device is positioned above the surgical field and out of the way. It also provides physicians with a three-dimensional view of the surgical field during an operation.

While this study focused on minimally invasive spine procedures like anterior cervical decompressions and fusions, Sunil Patel—also of MUSC—points to the exoscope’s use in any surgery that requires magnification.

“Including the robotic aspect of this tool, you have factors that lead to a more fluent surgery,” he stated. “You have fewer errors with better visualisation, which leads to better patient outcomes.”

As per a news release from MUSC, neurosurgeons often perform spine procedures in positions that are not good for their posture. The release cites an Acta Neurochirurgica study in which more than 60% of neurosurgeons reported low back pain and 31% were found to have been diagnosed with lumbar disc herniation.

With its high level of magnification, better lighting and greater position flexibility, the 3D exoscope allows for a more natural posture during surgery, which Kalhorn noted is much more comfortable and allows him to be more efficient during surgery.

MUSC’s Noah Nawabi—first author on the study—added that, while the exoscope cannot be connected directly to more favourable clinical results, patients whose surgeons used the exoscope had significantly shorter times in the operating room as well as shorter hospital stays than those with the operative microscope.

Kalhorn and Nawabi believe this could be very impactful, clinically, for minimally invasive spinal surgeries, as the increased level of visualisation allows for smaller incisions and less blood loss for the patient while also being more comfortable for the surgeon.

Surgical views can even be shared between multiple surgeons and residents simultaneously during surgery, making it a useful teaching tool as well—and Nawabi said it has been an effective learning tool for him.

“Its ability to provide the attending surgeon’s view to everyone involved in the case makes it an unmatched facilitator of observation,” he averred. “It helped me establish an early understanding of basic neurosurgical anatomy and approaches.”

Nawabi went on to note that the results of this study are in line with other, similar studies, but that the literature around exoscopes versus microscopes for spinal surgery was “lacking”. Nawabi also feels that these results suggest that more surgeons may wish to explore using the exoscope for their spinal surgeries in the future.

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