• Ahmad Hafez, Ahmed Elsharkawy, Christoph Schwartz, Sajjad Muhammad, Aki Laakso, Mika Niemelä, and Martin Lehecka.
• Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland. Electronic address: ext-ahmad.hafez@hus.fi.
• World Neurosurg. 2020 Mar 1; 135: e293-e299.

BackgroundRecently, the use of digital exoscopes has been increasingly promoted as an alternative to microscopes. The aim of this study is to compare experimental bypass quality in both visualization methods.MethodsThis study used two hundred 1-mm chicken wing vessels, which were used for either exoscopic or microscopic (100 samples each) bypass procedures. All procedures were recorded between July 2018 and September 2018. The bypass quality was evaluated according to our published practical scale (time, stitch distribution, intima-intima attachment, and orifice size).ResultsBoth methods are effective in doing bypass suturing (practical scale score was good, 86% vs. 85%; P = 0.84). There were no significant differences regarding intima-intima attachment (P = 0.26) and orifice size (P = 0.25). However, suturing time (P < 0.001) was less using the microscope, whereas stitch distribution (P = 0.001) was better using the exoscope. Different suturing techniques (interrupted vs. continuous) had overall comparable results (P = 0.55).ConclusionsBoth methods produced equally satisfactory results in experimental bypass procedures. The exoscope has the potential for better 3-dimensional visualization and sharing the surgeon's view with others for teaching purposes.Copyright © 2019 Elsevier Inc. All rights reserved.

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