Visualization and Maneuverability Features of a Robotic Arm Three-Dimensional Exoscope and Operating Microscope for Clipping an Unruptured Intracranial Aneurysm: Video Comparison and Technical Evaluation

BACKGROUND: In recent years, three-dimensional (3D) digital exoscope systems have been developed and reported to form an adequate alternative to the conventional operating microscope.

OBJECTIVE: To illustrate essential and practical features in a surgical video comparing a robotic arm 3D digital exoscope and a conventional operating microscope to clip a middle cerebral artery aneurysm.

METHODS: We used a mouth switch-controlled operating microscope (OPMI PENTERO 900; Carl Zeiss Meditec AG) and robotic arm-controlled 3D digital Aeos exoscope (Aesculap Inc). We assessed the following visualization and optical features: overall visualization quality, color and contrast quality, range and quality of magnification, and adjustment of focus. In addition, we assessed maneuverability for changing surgical site within and viewing angle of the surgical field.

RESULTS: We found that both modalities are suitable for this surgery and offer distinct qualities. The microscope enables faster magnification adjustment and continuous mouth switch-controlled focus adjustments. The advantages of the exoscope include the adaptation of color and contrast settings, and the surgeon can keep both hands in the surgical field while the camera pivots around its working field.

CONCLUSION: The exoscope and operating microscope offer a similar high-quality visualization of, and smooth maneuvering within, the surgical field. The method of visualization and maneuvering is, however, very distinct. Therefore, a surgeon's acquaintance and experience with the specific features and how to optimally use them in surgery are of utmost importance. Further analyses of both systems are needed to evolve these tools.