Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery
Study Design Prospective observational study (n=74). Purpose To evaluate the learning curve for exoscope and three-dimensional (3D) 4K hybrid visualization in terms of operating time, advantages, disadvantages, and surgical complications in tubular-access minimally invasive spine surgery (MISS) and...
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| Format: | Article |
| Language: | English |
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Korean Spine Society
2020-02-01
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| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://asianspinejournal.org/upload/pdf/asj-2019-0075.pdf |
| _version_ | 1811227248754163712 |
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| author | Mohd Hisam Muhamad Ariffin Kamalnizat Ibrahim Azmi Baharudin Azmi Mohd Tamil |
| author_facet | Mohd Hisam Muhamad Ariffin Kamalnizat Ibrahim Azmi Baharudin Azmi Mohd Tamil |
| author_sort | Mohd Hisam Muhamad Ariffin |
| collection | DOAJ |
| description | Study Design Prospective observational study (n=74). Purpose To evaluate the learning curve for exoscope and three-dimensional (3D) 4K hybrid visualization in terms of operating time, advantages, disadvantages, and surgical complications in tubular-access minimally invasive spine surgery (MISS) and to assess surgeon satisfaction with image quality, ergonomics, and ability to perform target site treatment. Overview of Literature Working through tubular retractors poses a challenge. The extreme angulations during microsurgical decompression, especially contralateral decompression, require surgeons to work non-ergonomically. An exoscope allows surgeons to work ergonomically and independently of the microscope oculars as visualizations are now provided by large 3D 4K monitors. However, the value and efficacy of solely depending on an exoscope and 3D 4K monitors during microsurgical work are still unknown. Methods Seventy-four patients (99 levels) underwent trans-tubular MISS between March 2018 and January 2019. Five patients were excluded: one had pyogenic discitis, two had revisions, and two were trans-tubular transoral. In total, we analyzed 69 for operating time, blood loss, and complications. The learning curve graph was plotted using the surgical time for each procedure. Surgeons were asked to rate their satisfaction with image quality, ability to maintain ergonomic posture, and efficient target site treatment. Results For tubular microdiscectomy, the operating time plateaued after six cases, and for tubular decompression and minimally invasive transforaminal lumbar interbody fusion, the operating time plateaued after nine cases. Mean operating time was significantly reduced after the plateau. Complications included four cases of dural tear. All patients improved symptomatically, and there were no postoperative neurological deficits. Conclusions Use of the exoscope has a short learning curve. Surgeons benefit from improved ergonomic posture during surgery, and resident teaching appears to be good. The only drawback is the need to rearrange the operating table setup. Complications were comparable to those when using the surgical microscope. An exoscope with hybrid digital visualization provides excellent visualization, depth perception, clarity, and precision target site treatment. |
| first_indexed | 2024-04-12T09:39:25Z |
| format | Article |
| id | doaj.art-dd6d6c5ef3e14d1c9637544f5a22c34d |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-04-12T09:39:25Z |
| publishDate | 2020-02-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-dd6d6c5ef3e14d1c9637544f5a22c34d2022-12-22T03:38:08ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462020-02-01141596510.31616/asj.2019.00751119Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine SurgeryMohd Hisam Muhamad Ariffin0Kamalnizat Ibrahim1Azmi Baharudin2Azmi Mohd Tamil3 Department of Orthopaedics, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia Department of Orthopaedics, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia Department of Orthopaedics, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia Department of Public Health, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, MalaysiaStudy Design Prospective observational study (n=74). Purpose To evaluate the learning curve for exoscope and three-dimensional (3D) 4K hybrid visualization in terms of operating time, advantages, disadvantages, and surgical complications in tubular-access minimally invasive spine surgery (MISS) and to assess surgeon satisfaction with image quality, ergonomics, and ability to perform target site treatment. Overview of Literature Working through tubular retractors poses a challenge. The extreme angulations during microsurgical decompression, especially contralateral decompression, require surgeons to work non-ergonomically. An exoscope allows surgeons to work ergonomically and independently of the microscope oculars as visualizations are now provided by large 3D 4K monitors. However, the value and efficacy of solely depending on an exoscope and 3D 4K monitors during microsurgical work are still unknown. Methods Seventy-four patients (99 levels) underwent trans-tubular MISS between March 2018 and January 2019. Five patients were excluded: one had pyogenic discitis, two had revisions, and two were trans-tubular transoral. In total, we analyzed 69 for operating time, blood loss, and complications. The learning curve graph was plotted using the surgical time for each procedure. Surgeons were asked to rate their satisfaction with image quality, ability to maintain ergonomic posture, and efficient target site treatment. Results For tubular microdiscectomy, the operating time plateaued after six cases, and for tubular decompression and minimally invasive transforaminal lumbar interbody fusion, the operating time plateaued after nine cases. Mean operating time was significantly reduced after the plateau. Complications included four cases of dural tear. All patients improved symptomatically, and there were no postoperative neurological deficits. Conclusions Use of the exoscope has a short learning curve. Surgeons benefit from improved ergonomic posture during surgery, and resident teaching appears to be good. The only drawback is the need to rearrange the operating table setup. Complications were comparable to those when using the surgical microscope. An exoscope with hybrid digital visualization provides excellent visualization, depth perception, clarity, and precision target site treatment.http://asianspinejournal.org/upload/pdf/asj-2019-0075.pdfexoscopeminimally invasive spine surgery |
| spellingShingle | Mohd Hisam Muhamad Ariffin Kamalnizat Ibrahim Azmi Baharudin Azmi Mohd Tamil Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery Asian Spine Journal exoscope minimally invasive spine surgery |
| title | Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery |
| title_full | Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery |
| title_fullStr | Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery |
| title_full_unstemmed | Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery |
| title_short | Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery |
| title_sort | early experience setup learning curve benefits and complications associated with exoscope and three dimensional 4k hybrid digital visualizations in minimally invasive spine surgery |
| topic | exoscope minimally invasive spine surgery |
| url | http://asianspinejournal.org/upload/pdf/asj-2019-0075.pdf |
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