Artikel
First surgical experience with a high-definition 3-dimensional exoscope for cerebral bypass surgery in moyamoya patients
Erste Erfahrungen mit einem High-Definition-3-Dimensional-Exoskop in der zerebralen Bypass-Chirurgie bei Moyamoya-Patienten
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Autoren
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Frank Diesner
- Alfried Krupp Krankenhaus, Neurochirurgie, Essen, Deutschland
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Benjamin Steinhilber
- Universitätsklinikum Tübingen, Arbeitsmedizin, Tübingen, Deutschland
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Florian Ebner
- Alfried Krupp Krankenhaus, Neurochirurgie, Essen, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Cerebral bypass surgery is the treatment of choice for Moyamoya patients with diminished cerebral perfusion. The standard superficial temporal artery to middle cerebral artery bypass (STA-MCA) is a technically demanding procedure which requires excellent optical visualisation and magnification. The current gold standard are high-end operating microscopes (OM). However, they have well known ergonomic drawbacks. Exoscope (EX) systems have been proposed as an alternative in microsurgery with the potential to improve ergonomics and offer digital features.
The Objective is to report surgical and ergonomic aspects of our first experience using a robotic-assisted High-Definition (HD) 3-Dimensional (3D) EX system for cerebral bypass surgery
Methods: Over a 2 months period we operated Moyamoya patients who recieved cerebral bypass surgery at our institution utilising the HD 3D EX. For objective assessment the surgeon completed the Nordic questionnaire and a six items questionnaire including aspects of usability, body posture, working precision, mental and physical effort. The same was done for bypass surgeries performed with the high-end OM. Technical and ergonomic aspects of the visualisation systems and clinical outcome of the patients were assessed and compared.
Results: A total of 5 patients underwent STA-MCA bypass surgery with the exoscope sytem. No complications occurred and all bypasses were patent. The slim design of the EX promoted a simple surgical set up and application of surgical instruments was no problem. Ergonomics for the surgeon were comfortable. In our set up the screen position limited the ergonomics for the cosurgeon. Operation time was longer due to a new procedure (mean operation time (min) EX / OM: 194 / 129). The 3D-effect was very impressive. However, digital picture quality seems to have slight disadvantages relating to colour discrimination in high resolution.
Conclusion: The 3D optic of the EX is suitable for cerebral bypass surgery. The evolution of digital picture quality is still in progress and provides unlimited possibilities. Therefore digital microscopes have the potential to become the next step in microsurgery.
