Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2023; 50(01): 125-129
DOI: 10.1055/s-0042-1758768
Communication

Three-Dimensional Video Microscopy: Potential for Improved Ergonomics without Increased Operative Time?

Yasmina Samaha 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
,
Edward Ray 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
› Author Affiliations Funding The authors have no commercial associations or financial disclosures to declare in relation to the content presented in this manuscript. No funding was received for this work.
› Further Information
   Permissions and Reprints

Abstract

Three-dimensional (3D) video exoscopes are high-magnification stereo cameras that project onto monitors mounted in the operating room, viewable from different angles. Outside of plastic surgery, exoscopes have been shown to successfully improve the ergonomics of microsurgery, though sometimes with prolonged operating times. We compare a single surgeon's early experience performing free flap procedures from 2020 to 2021 using either a binocular microscope or a 3D video exoscope. Ten procedures were performed with the standard operating microscope and 8 procedures with the 3D exoscope. The microsurgeon, having minimal prior experience using an exoscope, reported less neck discomfort following the free flap procedures performed with the exoscope compared with the binocular surgical microscope. Total average operating time was comparable between the standard surgical microscope and the 3D exoscope (13.7 vs. 13.4 hours, p = 0.34). Our early experience using a 3D exoscope in place of a standard optical microscope demonstrated that the exoscope shows promise, offering an ergonomic alternative during microvascular reconstruction without increasing overall operating times. Future studies will compare free flap ischemia time between cases performed using the exoscope and the conventional binocular microscope. Medical Subject Headings authorized following words: free tissue flaps; operating rooms; ergonomics; microsurgery.

Keywords

free tissue flaps - operating room - ergonomics - microsurgery - microscopes

Authors' Contributions

Y.S. and E.R. made substantial contributions to conception and design of the study, drafting and revisions, as well as performed data acquisition, analysis, and interpretation.


Patient Consent

Patients provided written informed consent for the publication and the use of their images.




Publication History

Received: 17 April 2022

Accepted: 01 September 2022

Article published online:
06 February 2023

© 2023. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ahmad FI, Mericli AF, DeFazio MV. et al. Application of the ORBEYE three-dimensional exoscope for microsurgical procedures. Microsurgery 2020; 40 (04) 468-472
    CrossrefPubMedGoogle Scholar
  • 2 Epstein S, Sparer EH, Tran BN. et al. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg 2018; 153 (02) e174947 DOI: 10.1001/jamasurg.2017.4947.
    CrossrefPubMedGoogle Scholar
  • 3 Ohlsson K, Attewell RG, Pålsson B. et al. Repetitive industrial work and neck and upper limb disorders in females. Am J Ind Med 1995; 27 (05) 731-747
    CrossrefPubMedGoogle Scholar
  • 4 Godwin Y, Macdonald CR, Kaur S, Zhelin L, Baber C. The impact of cervical musculoskeletal disorders on UK consultant plastic surgeons: can we reduce morbidity with applied ergonomics?. Ann Plast Surg 2017; 78 (06) 602-610
    CrossrefPubMedGoogle Scholar
  • 5 Capone AC, Parikh PM, Gatti ME, Davidson BJ, Davison SP. Occupational injury in plastic surgeons. Plast Reconstr Surg 2010; 125 (05) 1555-1561
    CrossrefPubMedGoogle Scholar
  • 6 Khansa I, Khansa L, Westvik TS, Ahmad J, Lista F, Janis JE. Work-related musculoskeletal injuries in plastic surgeons in the United States, Canada, and Norway. Plast Reconstr Surg 2018; 141 (01) 165e-175e
    CrossrefPubMedGoogle Scholar
  • 7 Oertel JM, Burkhardt BW. Vitom-3D for exoscopic neurosurgery: initial experience in cranial and spinal procedures. World Neurosurg 2017; 105: 153-162
    CrossrefPubMedGoogle Scholar
  • 8 Krishnan KG, Schöller K, Uhl E. Application of a compact high-definition exoscope for illumination and magnification in high-precision surgical procedures. World Neurosurg 2017; 97: 652-660
    CrossrefPubMedGoogle Scholar
  • 9 Mamelak AN, Danielpour M, Black KL, Hagike M, Berci G. A high-definition exoscope system for neurosurgery and other microsurgical disciplines: preliminary report. Surg Innov 2008; 15 (01) 38-46
    CrossrefPubMedGoogle Scholar
  • 10 Sack J, Steinberg JA, Rennert RC. et al. Initial experience using a high-definition 3-dimensional exoscope system for microneurosurgery. Oper Neurosurg (Hagerstown) 2018; 14 (04) 395-401
    CrossrefPubMedGoogle Scholar
  • 11 Takahashi S, Toda M, Nishimoto M. et al. Pros and cons of using ORBEYE™ for microneurosurgery. Clin Neurol Neurosurg 2018; 174: 57-62
    CrossrefPubMedGoogle Scholar
  • 12 Yu D, Green C, Kasten SJ, Sackllah ME, Armstrong TJ. Effect of alternative video displays on postures, perceived effort, and performance during microsurgery skill tasks. Appl Ergon 2016; 53 (Pt A): 281-289
    CrossrefPubMedGoogle Scholar
  • 13 Rossini Z, Cardia A, Milani D, Lasio GB, Fornari M, D'Angelo V. VITOM 3D: preliminary experience in cranial surgery. World Neurosurg 2017; 107: 663-668
    CrossrefPubMedGoogle Scholar
  • 14 Kwan K, Schneider JR, Du V. et al. Lessons Learned Using a High-Definition 3-Dimensional Exoscope for Spinal Surgery. Vol 16.; 2019. DOI: 10.1093/ons/opy196
    CrossrefGoogle Scholar
  • 15 Mamelak AN, Nobuto T, Berci G. Initial clinical experience with a high-definition exoscope system for microneurosurgery. Neurosurgery 2010; 67 (02) 476-483
    CrossrefPubMedGoogle Scholar
  • 16 Fiani B, Jarrah R, Griepp DW, Adukuzhiyil J. The role of 3D exoscope systems in neurosurgery: an optical innovation. Cureus 2021; 13 (06) e15878 DOI: 10.7759/cureus.15878.
    CrossrefPubMedGoogle Scholar
  • 17 Muhammad S, Lehecka M, Niemelä M. Preliminary experience with a digital robotic exoscope in cranial and spinal surgery: a review of the Synaptive Modus V system. Acta Neurochir (Wien) 2019; 161 (10) 2175-2180
    CrossrefPubMedGoogle Scholar
  • 18 Kokosis G, Dellon LA, Lidsky ME, Hollenbeck ST, Lee BT, Coon D. Prevalence of musculoskeletal symptoms and ergonomics among plastic surgery residents: results of a national survey and analysis of contributing factors. Ann Plast Surg 2020; 85 (03) 310-315
    CrossrefPubMedGoogle Scholar
  • 19 Wanibuchi M, Komatsu K, Akiyama Y, Mikami T, Mikuni N. Effectiveness of the 3D monitor system for medical education during neurosurgical operation. World Neurosurg 2018; 109: e105-e109
    CrossrefPubMedGoogle Scholar
  • 20 Piatkowski AA, Keuter XHA, Schols RM, van der Hulst RRWJ. Potential of performing a microvascular free flap reconstruction using solely a 3D exoscope instead of a conventional microscope. J Plast Reconstr Aesthet Surg 2018; 71 (11) 1664-1678
    CrossrefPubMedGoogle Scholar