Comparison of Operating Microscope and Exoscope in a Highly Challenging Experimental Setting

A. Hafez*, R.H.L. Haeren, J. Dillmann, A. Laakso, M. Niemela, M. Lehecka

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: The 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.METHODS: End-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.RESULTS: No 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.CONCLUSIONS: In 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.
Original languageEnglish
Pages (from-to)E468-E475
Number of pages8
JournalWorld Neurosurgery
Publication statusPublished - 1 Mar 2021


  • 3D exoscope
  • Bypass
  • Demanding situation
  • Neurosurgery
  • Operating microscope

Cite this