Stephan Herlan1,2, Jakob S Marquardt3, Bernhard Hirt2, Marcos Tatagiba1, Florian H Ebner1. 1. Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany. 2. Institute of Clinical Anatomy and Cell Analysis, Eberhard Karls University of Tübingen, Tübingen, Germany. 3. Department of Neurosurgery, Asklepios Klinik Nord, Heidberg, Hamburg, Germany.
Abstract
BACKGROUND: For decades, the operating microscope has been the "gold standard" visualization device in neurosurgery. The development of endoscopy revolutionized different surgical disciplines, whereas in neurosurgery, the endoscope is commonly used as an additional device more than as single visualization tool. Invention of a 3D exoscope system opens new possibilities in visualization and ergonomics in neurosurgery. OBJECTIVE: To assess the prototype of a 3D exoscope (3D exoscope, year of manufacture 2015, FA Aesculap, Tüttlingen, Germany) as neurosurgical visualization device in comparison to a standard operating microscope. METHODS: A pterional approach was performed in 3 ETOH-fixed specimens (6 sides). A standard operating microscope was compared to a 3D exoscope prototype. Dimensions like visual field, magnification, illumination, ergonomics, depth effect, and 3D impression were compared. RESULTS: In all approaches, the structures of interest could be clearly visualized with both devices. Magnification showed similar results. The exoscope had more magnification potential, whereas the visual quality got worse in higher magnification levels. The illumination showed better results in the microscope. Surgeons felt more comfortable with the 3D exoscope, concerning ergonomic considerations. Depth effect and 3D impression showed similar results. None of the surgeons felt uncomfortable using the exoscope. CONCLUSION: The operating microscope is the gold standard visualization tool in neurosurgery because of its illumination, stereoscopy, and magnification. Nevertheless, it causes ergonomic problems. The prototype of a 3D exoscope showed comparable features in visual field, stereoscopic impression, and magnification, with a clear benefit concerning the ergonomic possibilities.
BACKGROUND: For decades, the operating microscope has been the "gold standard" visualization device in neurosurgery. The development of endoscopy revolutionized different surgical disciplines, whereas in neurosurgery, the endoscope is commonly used as an additional device more than as single visualization tool. Invention of a 3D exoscope system opens new possibilities in visualization and ergonomics in neurosurgery. OBJECTIVE: To assess the prototype of a 3D exoscope (3D exoscope, year of manufacture 2015, FA Aesculap, Tüttlingen, Germany) as neurosurgical visualization device in comparison to a standard operating microscope. METHODS: A pterional approach was performed in 3 ETOH-fixed specimens (6 sides). A standard operating microscope was compared to a 3D exoscope prototype. Dimensions like visual field, magnification, illumination, ergonomics, depth effect, and 3D impression were compared. RESULTS: In all approaches, the structures of interest could be clearly visualized with both devices. Magnification showed similar results. The exoscope had more magnification potential, whereas the visual quality got worse in higher magnification levels. The illumination showed better results in the microscope. Surgeons felt more comfortable with the 3D exoscope, concerning ergonomic considerations. Depth effect and 3D impression showed similar results. None of the surgeons felt uncomfortable using the exoscope. CONCLUSION: The operating microscope is the gold standard visualization tool in neurosurgery because of its illumination, stereoscopy, and magnification. Nevertheless, it causes ergonomic problems. The prototype of a 3D exoscope showed comparable features in visual field, stereoscopic impression, and magnification, with a clear benefit concerning the ergonomic possibilities.
Authors: Anto Abramovic; Matthias Demetz; Aleksandrs Krigers; Marlies Bauer; Sara Lener; Daniel Pinggera; Johannes Kerschbaumer; Sebastian Hartmann; Helga Fritsch; Claudius Thomé; Christian F Freyschlag Journal: Brain Spine Date: 2021-12-28
Authors: Yi Zhang; Michael Zhang; Matthew Lin; Melanie Hayden Gephart; Anand Veeravagu; John K Ratliff; Gordon Li Journal: World Neurosurg Date: 2020-03-30 Impact factor: 2.210