1008. A New Era of Surgical Microscopes in Neurosurgery: The 4K-3D ORBEYE Exoscope

Authors: Julia R. Schneider; Timothy White, MD; Erez Nossek, MD; Rafael Ortiz, MD; Jason Ellis, MD; John Boockvar, MD; David Langer, MD (Staten Island, NY)

Introduction: Despite significant technological advancements in the operative microscope (OM), certain shortcomings remain. The limitations of the OM in optics, ergonomics, footprint, and educational value have been sought to be addressed by the ORBEYE exoscope. Methods: A single institutional, retrospective chart review was done between June 2017 and September 2018 to capture which operative cases were done using the ORBEYE exoscope by the senior author (DL). Clinical outcome, ergonomics, visualization, and overall feasibility were assessed retrospectively. Results: A total of 71 neurosurgical cases (25 vascular, 30 spine, 16 brain tumor) were done using the ORBEYE exoscope. Of the vascular cases there were 11 EC-IC bypasses, 11 aneurysm clippings, and 3 carotid endarteriectomies. Of the 30 spine cases, the majority were ACDF’s (8) and laminectomies (14). For vascular cases, the exoscope provided unprecedented clear visualization, which was especially helpful for bypass cases. For spine cases, the most noticeable benefit of the exoscope was its excellent ergonomics, specifically decreasing neck flexion, thereby decreasing physical burden. In brain tumor cases, the exoscope’s superior illumination and 4K-3D features was critical for tumor delineation in challenging surgical corridors. Common benefits among all cases include but are not limited to: shared visualization in the room that benefited surgical training, improved ergonomics for the assistant and primary surgeons, automatic focus, and impeccable screen integration of the navigational system. Conclusion: The ORBEYE exoscope’s ergonomics, optics, and ability to provide an engaging operative environment for everyone in the room is promising for its incorporation into the neurosurgical operating room. With technology advancing in all aspects of medicine, we believe that the OM must also improve to keep up with the rising generation of neurosurgeons. Further prospective trials using the exoscope are necessary and underway, including its role in ACGME neurosurgery residency programs.