Abstract


Objective: The high-definition 3D operating exoscope is a new tool for surgical visualization and magnification that was designed to replace the operating microscope. However, the paucity of studies that have prospectively compared the two systems has made it difficult to draw clear recommendations. The purpose of this study was to compare the operating exoscope and the operating microscope in first-time users in a pre-clinical setting.
Methods: Twenty-eight consecutive medical students were prospectively enrolled and randomized in a crossover design. Each student performed four exercises that required basic microsurgical skills. A tailored questionnaire (Comparison Assessment Tool) was used to subjectively compare the two systems using a 5-point Likert scale. The time needed to perform each task was recorded. A post-intervention cross-sectional survey was conducted to assess the overall quality of the trial session.
Results: The operating exoscope was preferred over the operating microscope by most of the students in all items of the Comparison Assessment Tool, particularly with regard to “focusing” and “image quality” (n = 25, 92.6%). A significant difference between groups was found in two exercises that were easier to perform with the operating exoscope. Most of the students considered the overall quality of the evaluation experience to be “very good” (n = 25, 92.6%).
Conclusions: The exoscope allows first-time users to better perform basic microsurgical tasks in a simulated clinical scenario compared to the operating microscope. Further prospective comparative studies will be needed to validate our preliminary findings in an actual clinical scenario.

Abstract


In video-based surgery (VBS), the surgeon is no longer the master of his or her view. Visualization of the surgical field is mediated by a video camera guided by an assistant. The separation of visualization and surgical activities leads to significant drawbacks. Early in the history of VBS, active camera holders controlled directly by the surgeon were introduced to replace the human camera assistant. However, despite remarkable technological advances over the past 25 years, robotic camera guidance systems (RCGS) still play only a marginal role. This is less due to inadequate mechanical designs or kinematics, and mainly due to inadequate human-machine interaction. In most cases, a simple task-shift is required that increases the surgeon’s mental workload instead of reducing it.
The current state of the art in robotic camera guidance, as represented by the SOLOASSIST II RCGS (AKTORmed, Neutraubling, Germany), includes a sophisticated combination of direct manual control, joystick navigation and high-quality voice control that provides the most intuitive surgeon-machine interaction currently available. An in-depth analysis of further clinical needs and promising developments in operating room integration suggests that the addition of context sensitivity could actually enhance the assistive effect of RCGS, making them potentially superior to the average human camera guidance.