3D, HD exoscopic assisted anterior cervical discectomy and fusion: a valid alternative to microscope-assisted surgery
EANS Academy. Certo F. 09/25/19; 275899; EP02049
Dr. Francesco Certo
Dr. Francesco Certo

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Abstract
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Anterior cervical discectomy and fusion (ACDF) remains one of the most commonly taught procedures during residency and one of the most frequently performed by neurosurgeons.
Neurosurgeons use the microscope to perform surgery and to train other surgeons. Although the microscope provides excellent illumination and magnification, its use is limited to two people: the surgeon and the assistant. Consequently, scrub nurse and residents watching 2D-images on monitors have reduced perception of the surgical field depth and anatomical details. The exoscope has been introduced as an alternative to microscopes or endoscopes.
We used a 3D, HD exoscope (3D Vitom®, Karl Storz, Tuttlingen, Germany) in two patients undergoing two-level ACDF for cervical myelo-radiculopathy.
The exoscope was used during soft-tissue dissection, discectomy, osteophytectomy and cage insertion. Microsurgical drilling of posterior osteophytes, which usually requires adequate magnification and proper microscope angulation, was also performed with the exoscope.
Exoscope provided a 3D view of the surgical field similar to a microscope and allowed us to effectively and safely perform the above surgical steps.
The main advantage of 3D exoscope-assisted surgery, compared to microscope-assisted surgery, is the possibility to generate videos with a similar view and image quality as perceived by the surgeon; therefore, the didactic capabilities of exoscopic videos are greater than those provided by microscopes. Exoscopes are also smaller compared to microscopes: this allows for comfortable use from early surgical steps to device implantation.
We think that exoscope-assisted surgery may become a safe and effective alternative to microscope-assisted surgery in ACDF.
Anterior cervical discectomy and fusion (ACDF) remains one of the most commonly taught procedures during residency and one of the most frequently performed by neurosurgeons.
Neurosurgeons use the microscope to perform surgery and to train other surgeons. Although the microscope provides excellent illumination and magnification, its use is limited to two people: the surgeon and the assistant. Consequently, scrub nurse and residents watching 2D-images on monitors have reduced perception of the surgical field depth and anatomical details. The exoscope has been introduced as an alternative to microscopes or endoscopes.
We used a 3D, HD exoscope (3D Vitom®, Karl Storz, Tuttlingen, Germany) in two patients undergoing two-level ACDF for cervical myelo-radiculopathy.
The exoscope was used during soft-tissue dissection, discectomy, osteophytectomy and cage insertion. Microsurgical drilling of posterior osteophytes, which usually requires adequate magnification and proper microscope angulation, was also performed with the exoscope.
Exoscope provided a 3D view of the surgical field similar to a microscope and allowed us to effectively and safely perform the above surgical steps.
The main advantage of 3D exoscope-assisted surgery, compared to microscope-assisted surgery, is the possibility to generate videos with a similar view and image quality as perceived by the surgeon; therefore, the didactic capabilities of exoscopic videos are greater than those provided by microscopes. Exoscopes are also smaller compared to microscopes: this allows for comfortable use from early surgical steps to device implantation.
We think that exoscope-assisted surgery may become a safe and effective alternative to microscope-assisted surgery in ACDF.
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