• Marc D Moisi, Kimberly Hoang, R Shane Tubbs, Jeni Page, Christian Fisahn, David Paulson, Shiveindra Jeyamohan, Johnny Delashaw, David Hanscom, Rod J Oskouian, and Jens Chapman.
• Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA. Electronic address: moisimd@aol.com.
• World Neurosurg. 2017 Feb 1; 98: 273-277.

IntroductionThe operating microscope (OM) has become instrumental in aiding surgeons during key microdissection with greater safety and detail. An exoscope offers similar detail with improved functionality and greater implications for live teaching and improved operating room flow.MethodsEleven senior neurosurgery residents and fellows performed unilateral, single-level laminotomies on fresh cadavers using an OM and exoscope. Three attending spine surgeons blinded for the visualization technique used then reviewed and graded each decompression. Data points gathered included time of procedure, grading of decompression (1-5), and complications, including dural tear, nerve root injury, and pars fracture.ResultsOperative times between the 2 systems were not significantly different (14.9 minutes OM vs. 15.6 minutes exoscope, P = 0.766). Despite high variability between evaluators in assessing complications and adequacy of decompression, there was no significant difference between either system. Postprocedural surveys indicated greater comfort with the exoscope, greater ease of use, and superior teaching potential for the exoscope over the standard OM.ConclusionIn our simulated operating room model, an exoscope is a valid alternative to the standard OM that affords the surgeon greater comfort with greater teaching potential while maintaining many of the microscope's benefits.Copyright © 2016 Elsevier Inc. All rights reserved.

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