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Evaluation of 3-Dimensional Exoscopes in Brain Tumor Surgery

  • Yoon, Wan-Soo (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lho, Hyoung-Woo (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Chung, Dong-Sup (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2020.07.13
  • 심사 : 2020.08.17
  • 발행 : 2021.03.01

초록

Objective : Though the operating microscope (OM) has been the standard optical system in neurosurgery, a new technology called three-dimensional (3D) exoscope has emerged as an alternative. Herein, two types of 3D exoscopes for brain tumor surgery are presented. In addition, the advantages and limitations compared with the OM are discussed. Methods : In the present study, 3D exoscope VOMS-100 or VITOM 3D was used in 11 patients with brain tumor who underwent surgical resection; the Kinevo 900 OM was used only in emergency. After completion of all surgeries, the participants were surveyed with a questionnaire regarding video image quality on the display monitor, handling of equipment, ergonomics, educational usefulness, 3D glasses, and expectation as a substitute for the OM. Results : Among 11 patients, nine patients underwent neurosurgical resection with only 3D exoscope; however, two patients required additional aid with the OM due to difficulty in hemostasis. Regarding video image quality, VITOM 3D was mostly equivalent to the OM, but VOMS-100 was not. However, both 3D exoscopes showed advantages in accessibility of instruments in the surgical field and occupied less space in the operating theater. Differences in ergonomics and educational usefulness between the exoscopes were not reported. Respondents did not experience discomfort in wearing 3D glasses and thought the exoscopes could be currently, and in the future, used as a substitute for the OM. Conclusion : Although many neurosurgeons are not familiar with 3D exoscopes, they have advantages compared with the OM and similar image quality. Exoscopes could be a substitute for OM in the future if some limitations are overcome.

키워드

참고문헌

  1. Beez T, Munoz-Bendix C, Beseoglu K, Steiger HJ, Ahmadi SA : First clinical applications of a high-definition three-dimensional exoscope in pediatric neurosurgery. Cureus 10 : e2108, 2018
  2. Gildenberg PL, Labuz J : Stereotactic craniotomy with the exoscope. Stereotact Funct Neurosurg 68 : 64-71, 1997 https://doi.org/10.1159/000099905
  3. Gildenberg PL, Labuz J : Use of a volumetric target for image-guided surgery. Neurosurgery 59 : 651-659, 2006 https://doi.org/10.1227/01.NEU.0000227474.21048.F1
  4. Gildenberg PL, Ledoux R, Cosman E, Labuz J : The exoscope-a frame-based video/graphics system for intraoperative guidance of surgical resection. Stereotact Funct Neurosurg 63 : 23-25, 1994 https://doi.org/10.1159/000100285
  5. Jacobson JH 2nd, Wallman LJ, Schumacher GA, Flanagan M, Suarez EL, Donaghy RM : Microsurgery as an aid to middle cerebral artery endarterectomy. J Neurosurg 19 : 108-115, 1962 https://doi.org/10.3171/jns.1962.19.2.0108
  6. KARL STORZ. Highlights MICROSCOPY. Available at : https://www.karlstorz.com/cps/rde/xbcr/karlstorz_assets/ASSETS/3620832.pdf
  7. Kuchta J, Simons P : Spinal neurosurgery with the head-mounted "varioscope" microscope. Cent Eur Neurosurg 70 : 98-100, 2009 https://doi.org/10.1055/s-0028-1087213
  8. Mamelak AN, Danielpour M, Black KL, Hagike M, Berci G : A high-definition exoscope system for neurosurgery and other microsurgical disciplines: preliminary report. Surg Innov 15 : 38-46, 2008 https://doi.org/10.1177/1553350608315954
  9. Mamelak AN, Nobuto T, Berci G : Initial clinical experience with a high-definition exoscope system for microneurosurgery. Neurosurgery 67 : 476-483, 2010 https://doi.org/10.1227/01.NEU.0000372204.85227.BF
  10. Nishiyama K : From exoscope into the next generation. J Korean Neurosurg Soc 60 : 289-293, 2017 https://doi.org/10.3340/jkns.2017.0202.003
  11. Oertel JM, Burkhardt BW : Vitom-3D for exoscopic neurosurgery: initial experience in cranial and spinal procedures. World Neurosurg 105 : 153-162, 2017 https://doi.org/10.1016/j.wneu.2017.05.109
  12. Ricciardi L, Chaichana KL, Cardia A, Stifano V, Rossini Z, Olivi A, et al. : The exoscope in neurosurgery: an innovative "point of view". A systematic review of the technical, surgical, and educational aspects. World Neurosurg 124 : 136-144, 2019 https://doi.org/10.1016/j.wneu.2018.12.202
  13. Rossini Z, Cardia A, Milani D, Lasio GB, Fornari M, D'Angelo V : VITOM 3D: preliminary experience in cranial surgery. World Neurosurg 107 : 663-668, 2017 https://doi.org/10.1016/j.wneu.2017.08.083
  14. SOMETECH Co., Ltd. 3D surgical video microscope (model : VOMS-100). Available at : http://www.sometech.com/bbs/product_view.php?pmode=view&idx=3&cat_no=2&offset=
  15. Uluc K, Kujoth GC, Baskaya MK : Operating microscopes: past, present, and future. Neurosurg Focus 27 : E4, 2009