Crimi Nicole, Spiegel Jennifer L, Ungar Omer J, Le Trung N, Lin Vincent Y W, Bajin Munir D, Pirouzmand Farhad, Chen Joseph M
Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
Laryngoscope. 2025 Jul;135(7):2564-2573. doi: 10.1002/lary.32104. Epub 2025 May 10.
The three-dimensional (3D) exoscope is an innovative viewing platform in microsurgery with the potential of offering improved ergonomics and surgical performance. This study systematically evaluated the ergonomic characteristics, visualization, and subjective performance of an exoscope system compared to the microscope in cochlear implantation (CI) and translabyrinthine resection of vestibular schwannomas (VS).
This prospective qualitative study was performed at a tertiary referral center. Ergonomics were evaluated subjectively with questionnaires in addition to the Rapid Upper Limb Assessment Tool (RULA), which was used as a quantitative measure of ergonomic risk. Performance and visualization parameters were assessed at specific surgical milestones in comparing the exoscope to the microscope.
Ergonomically, exoscopic surgery led to less straining in both subjective (p < 0.001) and objective (p < 0.001) measures. Visualization in terms of expansiveness, visual clarity, and depth was superior at each surgical milestone in VS (exoscope n = 7; microscope n = 5) and most of the CI milestones (exoscope n = 24; microscope n = 22). CI surgeries were completed faster with the exoscope (p = 0.007).
The 3D-exoscope afforded clear ergonomic advantages as compared with the microscope in so far as to reduce strains and potentially long-term risks to surgeons. Additional advantages over the traditional surgical microscope included improvement in the field of view and visual clarity, with no effect on time to completion. Further advancements in exoscope technology will ease the adaptation of this innovative device in cochlear implant and translabyrinthe surgeries.
三维（3D）外视镜是显微外科手术中的一种创新观察平台，具有改善人体工程学和手术性能的潜力。本研究系统评估了外视镜系统与显微镜相比，在人工耳蜗植入（CI）和前庭神经鞘瘤（VS）经迷路切除术的人体工程学特征、可视化效果和主观性能。
这项前瞻性定性研究在一家三级转诊中心进行。除了使用快速上肢评估工具（RULA）作为人体工程学风险的定量测量方法外，还通过问卷调查对人体工程学进行主观评估。在将外视镜与显微镜进行比较时，在特定手术阶段评估性能和可视化参数。
在人体工程学方面，外视镜手术在主观（p < 0.001）和客观（p < 0.001）测量中导致的紧张程度均较低。在VS的每个手术阶段（外视镜n = 7；显微镜n = 5）以及大多数CI阶段（外视镜n = 24；显微镜n = 22），在外展性、视觉清晰度和深度方面的可视化效果更好。使用外视镜完成CI手术更快（p = 0.007）。
与显微镜相比，3D外视镜具有明显的人体工程学优势，可减少外科医生的紧张程度和潜在的长期风险。与传统手术显微镜相比的其他优势包括视野和视觉清晰度的改善，且对完成时间没有影响。外视镜技术的进一步发展将有助于这种创新设备在人工耳蜗植入和经迷路手术中的应用。
