• Ahmad Hafez, HaerenRoel H LRHLDepartment of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands., Johannes Dillmann, Aki Laakso, Mika Niemelä, and Martin Lehecka.
• Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: ext-ahmad.hafez@hus.fi.
• World Neurosurg. 2021 Mar 1; 147: e468-e475.

BackgroundThe use of a digital three-dimensional (3D) exoscope system in neurosurgery is increasing as an alternative to the operative microscope. The objective of this study was to compare a digital 3D exoscope system with a standard operating microscope as a neurosurgical visualization tool in a highly challenging experimental setting.MethodsEnd-to-side bypass procedures, each at a depth of 9 cm, were performed in a simulation setting. The quality of the task and the depth effect, visualization, magnification, illumination, and ergonomics were evaluated.ResultsNo major differences were noted between the microscope and the 3D exoscope in terms of the quality of the work. Working with the 3D exoscope was more time-consuming than working with the microscope. Changing the depth and focus was faster using the operative microscope. The 3D exoscope enabled higher magnification and offered better ergonomic features.ConclusionsIn a highly challenging experimental setting, comparable procedural quality was found for the microscope and the 3D exoscope. Each visualization tool had advantages and disadvantages. Over time and with technologic advances, the digital 3D exoscope may become the main operative visualization system in microneurosurgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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