BACKGROUND The use of a digital 3D exoscope system in neurosurgery is increasing as an alternative to the operative microscope. The objective of this study was to compare the use of a digital 3D exoscope system to that of a standard operating microscope as a neurosurgical visualization tool in a highly challenging, experimental setting. METHODS End-to-side bypass procedures, each at a depth of 9 centimeters, were performed in a simulation setting. The quality of the task as well as the depth effect, visualization, magnification, illumination, and ergonomics were evaluated. RESULTS No major differences were noted between the microscope and the exoscope in terms of the quality of the work. Working with the exoscope was more time-consuming than working with the microscope. Changing the depth and focus was faster using the operative microscope. The exoscope enabled higher magnification and it offered better ergonomic features. CONCLUSION In a highly challenging, experimental setting, comparable procedural quality was found for both visualization modalities. Each had its own advantages and disadvantages. Over time and with technological advances, the digital 3D exoscope may become the main operative visualization system in microneurosurgery.
Comparison of operating microscope and exoscope in a highly challenging experimental setting.