Monitor-based exoscopic 3D4k neurosurgical interventions: a two-phase prospective-randomized clinical evaluation of a no
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ORIGINAL ARTICLE - NEUROSURGICAL TECHNIQUE EVALUATION
Monitor-based exoscopic 3D4k neurosurgical interventions: a two-phase prospective-randomized clinical evaluation of a novel hybrid device Anna L. Roethe 1,2
&
Philipp Landgraf 3 & Torsten Schröder 3 & Martin Misch 1 & Peter Vajkoczy 1 & Thomas Picht 1,2
Received: 7 November 2019 / Accepted: 18 April 2020 # The Author(s) 2020
Abstract Background Promoting a disruptive innovation in microsurgery, exoscopes promise alleviation of physical strain and improved image quality through digital visualization during microneurosurgical interventions. This study investigates the impact of a novel 3D4k hybrid exoscope (i.e., combining digital and optical visualization) on surgical performance and team workflow in preclinical and clinical neurosurgical settings. Methods A pre-clinical workshop setting has been developed to assess usability and implementability through skill-based scenarios (neurosurgical participants n = 12). An intraoperative exploration in head and spine surgery (n = 9) and a randomized clinical study comparing ocular and monitor mode in supratentorial brain tumor cases (n = 20) followed within 12 months. Setup, procedure, case characteristics, surgical performance, and user experience have been analyzed for both ocular group (OG) and monitor group (MG). Results Brain tumor cases using frontal, frontoparietal, or temporal approaches have been identified as favorable use cases for introducing exoscopic neurosurgery. Mean monitor distance and angle were 180 cm and 10°. Surgical ergonomics when sitting improved significantly in MG compared with OG (P = .03). Hand-eye coordination required familiarization in MG. Preclinical data showed a positive correlation between lateral camera inclination and impact on hand-eye coordination (rs = 0.756, P = .01). There was no significant added surgical time in MG. Image quality in current generation 3D4k monitors has been rated inferior to optic visualization yet awaits updates. Conclusions The hybrid exoscopic device can be integrated into established neurosurgical workflows. Currently, exoscopic interventions seem most suited for cranial tumor surgery in lesions that are not deep-seated. Ergonomics improve in monitor mode compared to conventional microsurgery. Keywords Brain tumor . Digital innovation . Exoscope . Intraoperative visualization . Technology evaluation
This article is part of the Topical Collection on CSF Neurosurgical technique evaluation Selected results of this research have been previously presented at the annual meeting of the German neurosurgical society in Münster, Germany, June 4, 2018 (doi: 10.3205/18dgnc387) and in Würzburg, Germany, May 13, 2019 (doi: 10.3205/19dgnc091). German Clinical Trials Register No DRKS00016674 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04361-2) contains supplementary material, which is available to authorized users. * Anna L. Roethe [email protected] Extended author information available on the last pa
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