gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

First clinical experience with a hybrid robotic exoscopic visualisation system

Erste klinische Erfahrungen mit einem hybriden robotischen Exoskop-System

Meeting Abstract

  • presenting/speaker Frederik Enders - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
  • Jason Perrin - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
  • Amr Abdulazim - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
  • Daniel Hänggi - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV078

doi: 10.3205/19dgnc093, urn:nbn:de:0183-19dgnc0938

Published: May 8, 2019

© 2019 Enders et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Visualization for microneurosurgery has traditionally been realized by fully optic microscopes. Facilitated by technical improvements in 3D digital camera and image display, exoscopic visualization tools gained clinical usability over the last years. Nevertheless, exoscopic technique has limitations for very high magnification and cannot be used in fluorescence guided surgery, which necessitates intraoperative change to the classic microscope. We report our first experience in exoscopic surgery with a robotic hybrid microscope/exoscope system in the clinical setting.

Methods: The exoscope system was used in the clinical routine for cranial and spinal cases. Usability was retrospectively evaluated using a five-point Likert-scale for the surgeon and assistant each. Evaluated items include ergonomics (head/body position, instrument working space, interaction with OR staff, exoscope repositioning, comfort of 3D glasses), visualization (overall optic quality, 3D impression, illumination, colour, reflexion) and workflow (OR time, logistic efforts).

Results: For evaluation 21 cases (8 spinal, 13 cranial) were included. Results for ergonomics were mainly dependent on type of surgery. For supratentorial, retrosidmoid and posterior spinal approaches ergonomics reached very satisfying results. Particularly, positional change of the optics could be performed without using hands by the robotic remote control pedal. However, for suboccipital and anterior cervical approaches, architecture of the exoscopic system was found to impede ergonomic comfort. For visualization, results were found to be satisfying, though 3D impression was dependent on accurate screen-surgeon position and could be affected when changing the the surgeon’s position. Of note, in five patients undergoing fluorescence guided surgery (5ALA, ICG) the exoscope/microscope mode could be easily changed with one maneuver.

Conclusion: In the author’s opinion the hybrid robotic exoscopic visualization system is a useful tool for microneurosurgery. Its use is limited in procedures where the optic apparatus is placed between the surgeon and situs in acute angle trajectories (e.g. suboccipital approaches). Moreover, integration of the screen into the OR setting and positioning in relation to the surgical team influences the OR workflow. The authors see main advantages in improved ergonomics due to handless/mouthless positional change. Furthermore, the hybrid design allows easy change to microscopic mode including fluorescence features.

Figure 1 [Fig. 1]