• Barbagallo Giuseppe M V GMV Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy. and Francesco Certo.
• Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
• World Neurosurg. 2019 Oct 1; 130: e244-e250.

BackgroundAnterior cervical discectomy and fusion (ACDF) remains one of the most commonly taught procedures during residency and one of the most frequently performed by neurosurgeons. Neurosurgeons use microscopes to perform surgery and to train other surgeons. Although the microscope provides excellent illumination and magnification, its use will be limited to 2 people: the surgeon and the assistant. Consequently, the scrub nurse and residents watching 2-dimensional images on monitors will have a reduced perception of the surgical field depth and anatomical details. The exoscope has been introduced as an alternative to microscopes and endoscopes. We used a 3-dimensional (3D), high-definition exoscope (3D Vitom [Karl Storz, Tuttlingen, Germany]) in 2 patients undergoing 2-level ACDF for cervical myeloradiculopathy.MethodsThe exoscope was used during soft tissue dissection, discectomy, osteophytectomy, and cage insertion. Microsurgical drilling of the posterior osteophytes, which will usually require adequate magnification and proper microscope angulation, was also performed using the exoscope.ResultsThe exoscope provided a 3D view of the surgical field similar to that provided by a microscope and allowed us to effectively and safely perform the required surgical steps. The main advantage of 3D exoscope-assisted surgery, compared with microscope-assisted surgery, is the possibility to generate videos with a similar view and image quality as perceived by the surgeon. Therefore, the didactic capabilities of exoscopic videos are greater than those provided by microscopic videos. Exoscopes are also smaller compared with microscopes, allowing for comfortable use from the early surgical steps to device implantation.ConclusionWe believe that exoscope-assisted surgery could become a safe and effective alternative to microscope-assisted surgery in ACDF.Copyright © 2019 Elsevier Inc. All rights reserved.

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