gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

First laboratory and clinical experiences with a new 3D/HD exoscope for transcranial neurosurgical procedures

Meeting Abstract

  • Peter Prömmel - Endomin, Zentrum für endoskopische und minimalinvasive Neurochirurgie, Klinik Hirslanden, Zürich, Switzerland
  • Marton Eördögh - Hannover, Deutschland
  • Anne-Katrin Hickmann - Zürich, Switzerland
  • Peter Kurucz - Stuttgart, Deutschland
  • Nikolai Hopf - Stuttgart, Deutschland
  • Robert Reisch - Zürich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.23.04

doi: 10.3205/17dgnc310, urn:nbn:de:0183-17dgnc3106

Published: June 9, 2017

© 2017 Prömmel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: The introduction of the operating microscope over half a century ago was the crucial step in the development of modern neurosurgery. Despite several especially ergonomic disadvantages, it is an indispensable tool in most of neurosurgical procedures today. Goal of the study was to evaluate a new 3D/HD exoscope operating system for transcranial minimal invasive neurosurgical procedures with capability to replace the operating microscope in the future.

Methods: In a first step, the 3D/HD exoscope (Vitom 3D, Karl Storz, Tuttlingen/Germany) was evaluated on 5 fixed as well as on 20 fresh cadavers. 31 keyhole approaches (supraorbital; supraorbital basal; mini-pterional, interhemispheric anterior, middle, posterior; subtemporal; transcortical; supracerebellar; retrosigmoidal; paramedian suboccipital) were performed in fresh human cadavers. After this preclinical evaluation, the 3D/HD exoscope was used in 9 neurosurgical procedures (1 transcortical resection of metastasis; 1 interhemispheric resection of metastasis; 2 median suboccipital resection of 4th ventricle tumor, intracereballar metastasis and tentorial meningeoma; 3 retrosigmoidal approaches for trigeminal neuralgia, facial spasm and retroclival meningioma; 1 two-level anterior cervical discectomy and fusion). The cases were performed subsequently in a 5 day period without preselection. Surgical manipulations were performed under visual control on a 3D monitor (Karl Storz, Tuttlingen/Germany). Performance was compared to a standard operating microscope (Carl Zeiss Meditec AG, Oberkochen/Germany) and 18 aspects of imaging and suitability were rated as inferior, equal or superior

Results: The 3D/HD exoscope showed equal or superior performance in all used transcranial keyhole approaches concerning resolution of details, depth of field and stereoscopic vision. Improved performance was most obvious in the retrosigmoid and paramedian suboccipital approach according to superior ergonomics. Continuous preparations up to 4 hours could be performed without adverse effects like headache or fatigue. The 3D/HD exoscopes depth of field was significantly larger compared to the standard operating microscope which reduces the need of frequent re-focusing while working in deep surgical fields.

Conclusion: The new 3D/HD exoscope was found to be suitable for use in transcranial Neurosurgery. It showed an overall superior performance in the close-to-reality fresh cadaver model using a variety of different keyhole approaches and during 9 neurosurgical procedures. Larger series with additional functionality like fluorescence and navigation will evaluate the potential of the 3D/HD Exoscope to replace the operating microscope in the future.