Advancement of Surgical Visualization Methods: A Comparison Study between Traditional Microscopic Surgery and a Novel Robotic Optoelectronic Visualization Tool for Spinal Surgery

Abstract Introduction The operative microscope has become instrumental in aiding surgeons during key microdissection with greater safety and detail. An exoscope offers similar detail with improved functionality and greater implications for live-teaching and improved operating-room flow. Methods Eleven senior neurosurgery residents and fellows performed unilateral, single-level laminotomies on fresh cadavers using an operating microscope and exoscope. Three attending spine surgeons blinded for the visualization technique used then reviewed and graded each decompression. Data points gathered included time of procedure, grading of decompression (1-5), and complications, including dural tear, nerve root injury, and pars fracture. Results Operative times between the two systems were not significantly different (14.9 minutes OM versus 15.6 minutes exoscope p=0.766). Despite high variability between evaluators in assessing complications and adequacy of decompression, there was no significant difference between either system. Post-procedural surveys indicated greater comfort with the exoscope, greater ease of use, and superior teaching potential for the exoscope over the standard operative microscope. Conclusion In our simulated operating room model, an exoscope is a valid alternative to the standard operating microscope that affords the surgeon greater comfort with greater teaching potential while maintaining many of the microscopes benefits.