gms | German Medical Science

Objective: Fully digital exoscopes (videoscopes) consist of a camera mounted on a robotic arm and a high resolution 3D video monitor positioned independently. Exoscopic surgery in general promises alleviation of physical strain and improved intraoperative visualization. This study investigates the clinical usability of a novel 3D4k videoscope in neurosurgical routine interventions.

Methods: Based on a previous randomized trial on exoscopic neurosurgery, a documentation protocol comprising quantitative and qualitative data has been established. Intracranial, spinal and peripheral nerve procedures of low to intermediate complexity were included prospectively. All participating neurosurgeons (n=10) received initial device training. A complementary eyepiece as well as a conventional surgical microscope were available during surgery. Observational parameters, clinical data and scale instruments for user feedback were analyzed using descriptive statistics.

Results: Within 8 weeks, 29 cases were performed with the 3D4k videoscope (22 cranial, 6 spinal and 1 peripheral procedures), including 72% tumors, 14% epilepsy surgery and 10% nerve decompression/spinal stabilization. The overall experience was rated good by 70% of surgeons. Primary reasons for conversion to ocular-based surgery in 48% of cases were the discrepancy of working and viewing direction, impaired hand-eye coordination and limited depth perception in critical areas. The grading of image quality was high (resolution, sharpness, contrast, color fastness, luminance) to excellent (magnification). The videoscope allowed for an upright head position in 95% of the surgical time. Most surgeons used both hand and foot control for camera repositioning. Despite satisfactory robotics, the usability and speed of the foot panel was rated overall low. Surgical results of the exoscopic surgery (including the conversion rate) were non-inferior to historic matched-controls. Across all cases, setup integratability has been rated favorable due to device size and versatility.

Conclusion: The 3D4k videoscope investigated in this study can be integrated in established neurosurgical workflows. Surgical ergonomics improved compared to standard setups while hand-eye coordination required additional training. Mainly the good image quality and the direct single-hand control of the camera head added to overall user satisfaction. For experienced surgeons, the incentive to switch from conventional microscopy to next generation videoscopy greatly varies.