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Nawabi NLA, Saway BF, Cunningham C, Rhodes S, Kodali P, Pereira M, Patel SJ, Kalhorn SP. Intraoperative Performance with the Exoscope in Spine Surgery: An Institutional Experience. World Neurosurg 2024; 182:208-213. [PMID: 38061539 DOI: 10.1016/j.wneu.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND Exoscope use in spinal neurosurgery has become a promising surgical option providing enhanced operative field visibility and ergonomics. However, data on its use in spine surgery are underreported in the literature. We aimed to assess the intraoperative outcomes in exoscope-assisted spine surgery compared with similar procedures performed using the operative microscope. METHODS A retrospective review was performed of all spinal surgeries performed using an exoscope and, subsequently, an equal number of operative microscope cases performed by 2 senior surgeons at a single institution from 2016 to 2023. The variables included demographics, clinical presentation, surgical treatment, and operative outcomes. RESULTS A total of 123 exoscope spinal surgeries were performed on 116 unique patients with a mean age of 67 ± 14 years, of whom 60 (52%) were women. The microscope group included 126 surgeries on 120 unique patients with a mean age of 62 ± 14 years, of whom 53 (45%) were women. The mean blood loss (28 mL vs. 132 mL; P = 0.0009), operative time (83 minutes vs. 103 minutes; P = 0.006), and length of stay (1.04 days vs. 1.73 days; P = 0.02) were significantly less for the exoscope group than for the microscope group. CONCLUSIONS The use of the exoscope resulted in a shorter operative time, less blood loss, a shorter length of stay, and favorable clinical outcomes compared with the use of the operative microscope. Neurosurgeons should consider this seemingly efficacious and ergonomically favorable visual technology for spinal surgeries.
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Affiliation(s)
- Noah L A Nawabi
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Brian F Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Conor Cunningham
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sloan Rhodes
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Prudhvi Kodali
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Matheus Pereira
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sunil J Patel
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen P Kalhorn
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Gaffuri M, di Lullo AM, Trecca EMC, Russo G, Molinari G, Russo FY, Albera A, Mannelli G, Ralli M, Turri-Zanoni M. High-Definition 3D Exoscope in Pediatric Otorhinolaryngology: A Systematic Literature Review. J Clin Med 2023; 12:6528. [PMID: 37892666 PMCID: PMC10607561 DOI: 10.3390/jcm12206528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
This PRISMA-compliant systematic review aimed to investigate the use of and the most common procedures performed with the novel 3D 4K exoscope in surgical pediatric head and neck settings. METHODS Search criteria were applied to PubMed, EMBASE and the Cochrane Review databases and included all studies published up to January 2023 reporting 3D 4K exoscope-assisted surgeries in pediatric patients. After the removal of duplicates, selection of abstracts and full-text articles, and quality assessment, we reviewed eligible articles for number of patients treated, age, surgical procedures, and outcomes. RESULTS Among 54 potentially relevant records, 5 studies were considered eligible and included in this systematic review, with reported treatment data for 182 patients. The surgical procedures belong to the otologic field (121 cases), head and neck surgery (25 cases) and transoral surgery (36 cases). Exoscopy allowed high quality visualization of anatomical structures during cochlear implantation and during reconstruction in head and neck surgery; moreover, it improved the surgical view of surgeons, spectators and ENT students. CONCLUSIONS The use of 3D 4K exoscopy has shown promising potential as a valuable tool in pediatric ORL-head and neck surgery; nevertheless, further validation of these encouraging outcomes is necessary through larger-scale studies specifically focused on pediatric patients.
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Affiliation(s)
- Michele Gaffuri
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Otolaryngology—Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Antonella Miriam di Lullo
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples Federico II, Pansini Street n.5, 80131 Naples, Italy
- CEINGE—Advanced Biotechnology, Salvatore G. Street n.486, 80131 Naples, Italy
| | - Eleonora M. C. Trecca
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Maxillofacial Surgery and Otolaryngology, IRCCS Research Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy
- Department of Otolaryngology, University Hospital of Foggia, 71100 Foggia, Italy
| | - Gennaro Russo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, 80131 Napoli, Italy
| | - Giulia Molinari
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Otolaryngology—Head and Neck Surgery, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—Università di Bologna, 40138 Bologna, Italy
| | - Francesca Yoshie Russo
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Sense Organs, ENT Department, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Albera
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Giuditta Mannelli
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy
| | - Massimo Ralli
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Sense Organs, ENT Department, Sapienza University of Rome, 00185 Rome, Italy
| | - Mario Turri-Zanoni
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
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Giammalva GR, Paolini F, Meccio F, Giovannini EA, Provenzano A, Bonosi L, Brunasso L, Costanzo R, Gerardi RM, Di Bonaventura R, Signorelli F, Albanese A, Iacopino DG, Maugeri R, Visocchi M. Assessing the Training in Neurosurgery with the Implementation of VITOM-3D Exoscope: Learning Curve on Experimental Model in Neurosurgical Practice. Brain Sci 2023; 13:1409. [PMID: 37891778 PMCID: PMC10605262 DOI: 10.3390/brainsci13101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Innovation and continuous demand in the field of visual enhancing technologies and video streaming have led to the discovery of new systems capable of improving visualization and illumination of the surgical field. The exoscope was brought into neurosurgical routine, and nearly ten years later, modern 3D systems have been introduced and tested, giving encouraging results. (2) Methods: In order to evaluate the surgeon's confidence with the exoscope and their increasing ability in terms of time spent and quality of the final achievement since their first encounter with the technique, an experimental trial on 18 neurosurgeons from a single Institution was performed to evaluate the learning curve for the use of the VITOM-3D exoscope in neurosurgical practice on a model of brain and dura mater. (3) Results: A significant improvement in the quality of the performance, number of errors made, and reduction in the time was found after the third iteration of the task, by when almost all the participants felt more comfortable and confident. No significant differences between senior neurosurgeons and resident neurosurgeons were reported. (4) Conclusions: Our results show that three iterations are enough to gain confidence with the exoscope from its first use, regardless of previous experience and training with an operating microscope.
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Affiliation(s)
- Giuseppe Roberto Giammalva
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Federica Paolini
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Flavia Meccio
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Evier Andrea Giovannini
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Alessandra Provenzano
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Lapo Bonosi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Rosa Maria Gerardi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Rina Di Bonaventura
- Department of Neurosurgey, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, 00100 Rome, Italy; (R.D.B.); (F.S.); (A.A.); (M.V.)
| | - Francesco Signorelli
- Department of Neurosurgey, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, 00100 Rome, Italy; (R.D.B.); (F.S.); (A.A.); (M.V.)
| | - Alessio Albanese
- Department of Neurosurgey, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, 00100 Rome, Italy; (R.D.B.); (F.S.); (A.A.); (M.V.)
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.R.G.); (F.P.); (F.M.); (E.A.G.); (A.P.); (L.B.); (R.C.); (R.M.G.); (D.G.I.)
| | - Massimiliano Visocchi
- Department of Neurosurgey, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, 00100 Rome, Italy; (R.D.B.); (F.S.); (A.A.); (M.V.)
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Di Cristofori A, Graziano F, Rui CB, Rebora P, Di Caro D, Chiarello G, Stefanoni G, Julita C, Florio S, Ferlito D, Basso G, Citerio G, Remida P, Carrabba G, Giussani C. Exoscopic Microsurgery: A Change of Paradigm in Brain Tumor Surgery? Comparison with Standard Operative Microscope. Brain Sci 2023; 13:1035. [PMID: 37508967 PMCID: PMC10377370 DOI: 10.3390/brainsci13071035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The exoscope is a high-definition telescope recently introduced in neurosurgery. In the past few years, several reports have described the advantages and disadvantages of such technology. No studies have compared results of surgery with standard microscope and exoscope in patients with glioblastoma multiforme (GBM). METHODS Our retrospective study encompassed 177 patients operated on for GBM (WHO 2021) between February 2017 and August 2022. A total of 144 patients were operated on with a microscope only and the others with a 3D4K exoscope only. All clinical and radiological data were collected. Progression-free survival (PFS) and overall survival (OS) have been estimated in the two groups and compared by the Cox model adjusting for potential confounders (e.g., sex, age, Karnofsky performance status, gross total resection, MGMT methylated promoter, and operator's experience). RESULTS IDH was mutated in 9 (5.2%) patients and MGMT was methylated in 76 (44.4%). Overall, 122 patients received a gross total resection, 14 patients received a subtotal resection, and 41 patients received a partial resection. During follow-up, 139 (73.5%) patients experienced tumor recurrence and 18.7% of them received a second surgery. After truncation to 12 months, the median PFS for patients operated on with the microscope was 8.82 months, while for patients operated on with the exoscope it was >12 months. Instead, the OS was comparable in the two groups. The multivariable Cox model showed that the use of microscope compared to the exoscope was associated with lower progression-free survival (hazard ratio = 3.55, 95%CI = 1.66-7.56, p = 0.001). CONCLUSIONS The exoscope has proven efficacy in terms of surgical resection, which was not different to that of the microscope. Furthermore, patients operated on with the exoscope had a longer PFS. A comparable OS was observed between microscope and exoscope, but further prospective studies with longer follow-up are needed.
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Affiliation(s)
- Andrea Di Cristofori
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Francesca Graziano
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Piazza Ateneo Nuovo, 120126 Milan, Italy
| | - Chiara Benedetta Rui
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Piazza Ateneo Nuovo, 120126 Milan, Italy
| | - Diego Di Caro
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Gaia Chiarello
- Pathology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Giovanni Stefanoni
- Neurology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Chiara Julita
- Radiotherapy, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Santa Florio
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Davide Ferlito
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Gianpaolo Basso
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Giuseppe Citerio
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurointensive Care Unit, Department of Neuroscience, Fondazione IRCCS San Gerardo deiTintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Paolo Remida
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Giorgio Carrabba
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Carlo Giussani
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
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