gms | German Medical Science

Background: The basic necessities for any surgical operation are illumination, visualization and exposure and as operations became more sophisticated, magnification. All the above-mentioned four essentials have undergone massive and rapid transformation within the last century. Modern day surgery employs surgical loupes, operating microscopes and endoscopes with high-definition (HD) image transmission. All these tools have their own advantages and disadvantages. One of the recent developments is a compact magnifying exoscope system (ViTOM^®, Karl Storz, Tuttlingen, Germany). In this report we describe the application of this system for high precision surgical operations and discuss its advantages and pitfalls.

Materials and methods: For illumination and magnification we used the compact ViTOM^® exoscope-system together with the adjustable mechanical holding arm fastened to the operating table. We conducted 18 different high-precision operations using this system. The operations were as follows: decompression of degenerative lumbar and cervical spinal canal stenosis (n=5); removal of lumbar migrated disc herniations through a laminotomy approach (n=4); anterior cervical discectomy and intervertebral body fusion using a cage (n=1); removal of intraneural schwannomas under neuromonitoring (n=2); removal of a acute cerebellar hemorrhage (n=1); removal of a parafalcine atypical cerebral hematoma caused by a dural arterio-venous fistula (n=1); and microsutures and anastomoses of a 1 mm nerve (n=1), a 1.5 mm artery (n=1) and two 1.5 mm veins (n=2) respectively.

Results: ViTOM^® offered excellent, magnified and brilliantly illuminated HD-images of the surgical field. All the reported surgical operations were successfully completed from both the technical as well as the medical points of view. All patients benefited from the procedures they underwent. The main disadvantage was the adjustment and refocusing using the mechanical holding arm, however not pertinent to the visualization system itself. Although this is not a comparative evaluation, the time required for the surgical operation under ViTOM^® was not significantly different from the empirical times required for a same procedure performed under an operating microscope.

Conclusion: This pilot study has shown the magnifying exoscope to be an effective and less space-occupying alternative to the operating microscope. In visualization around the corners, the exoscope has a better potential than the microscope. With future technical and technological modifications of the system, the exoscope may be predicted to be the next generation in illumination, visualization, exposure and magnification for high-precision surgery.

Figure 1 [Fig. 1]