Exoscope for revision of right lateral femoral cutaneous nerve decompression

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Abstract

The exoscope serves as a valuable addition or alternative to traditional microscope systems in surgery, offering 3D visualization and magnification with enhanced maneuverability. In lateral femoral cutaneous nerve decompression for meralgia paresthetica, the exoscope is effective in identifying strictures of neural compression and minimizing iatrogenic nerve damage that may lead to improved pain management outcomes for patients. In this report, the specific case presented showcases how the exoscope aided in surgical decompression of the lateral femoral cutaneous nerve of a patient with refractory meralgia paresthetica with remote previous decompression and resultant scarring.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23162

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Most cited references 9

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The exoscope in neurosurgery: an innovative "point of view". A systematic review of the technical, surgical and educational aspects.

Luca Ricciardi, Kaisorn Chaichana, Andrea Cardia … (2019)

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The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation

Brian Fiani, Ryan Jarrah, Daniel Griepp … (2021)

The development of the three-dimensional (3D) exoscope is a marvel of technological innovation in modern surgical practice. While its predecessor, the operating microscope (OM), has long been the gold-standard surgical visualization modality, its particular limitations in terms of accessibility and ergonomic demand have led to the development of a more sophisticated, 3D model. Specifically, the 3D exoscope allows for an enhanced image quality of the surgical field, while also being more ergonomically favorable. Moreover, this device’s ability to handle delicate microsensitve procedures, along with its alleviation of surgeon fatigue, indicates great potential for neurosurgical application. For this narrative review, the authors queried PubMed database using the keyword “exoscope” to identify relevant studies involving the specialty of neurosurgery that were published in English language full text. The search yielded full-text English language-related articles regarding neurosurgical exoscope, its applications and limitations. The 3D exoscope uniquely allows for enhanced surgeon comfort and superior imaging of the patient’s real-time anatomy. However, the OM was described to having a slight image favorability with fusion and decompression surgery. Cost analysis is highlighted for its potential disparity. 3D exoscopes will potentially be incorporated with intelligent carriers and robotic surgical systems. Ultimately, with further studies highlighting its use, the 3D exoscope is expected to continue to imprint its status as one of the most efficient technological visualization tools in the future of neurosurgical practice.

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The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery

Nicola Montemurro, Alba Scerrati, Luca Ricciardi … (2022)

Background: Exoscopes are a safe and effective alternative or adjunct to the existing binocular surgical microscope for brain tumor, skull base surgery, aneurysm clipping and both cervical and lumbar complex spine surgery that probably will open a new era in the field of new tools and techniques in neurosurgery. Methods: A Pubmed and Ovid EMBASE search was performed to identify papers that include surgical experiences with the exoscope in neurosurgery. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) were followed. Results: A total of 86 articles and 1711 cases were included and analyzed in this review. Among 86 papers included in this review 74 (86%) were published in the last 5 years. Out of 1711 surgical procedures, 1534 (89.6%) were performed in the operative room, whereas 177 (10.9%) were performed in the laboratory on cadavers. In more detail, 1251 (72.7%) were reported as brain surgeries, whereas 274 (16%) and 9 (0.5%) were reported as spine and peripheral nerve surgeries, respectively. Considering only the clinical series (40 studies and 1328 patients), the overall surgical complication rate was 2.6% during the use of the exoscope. These patients experienced complication profiles similar to those that underwent the same treatments with the OM. The overall switch incidence rate from exoscope to OM during surgery was 5.8%. Conclusions: The exoscope seems to be a safe alternative compared to an operative microscope for the most common brain and spinal procedures, with several advantages that have been reached, such as an easier simplicity of use and a better 3D vision and magnification of the surgical field. Moreover, it offers the opportunity of better interaction with other members of the surgical staff. All these points set the first step for subsequent and short-term changes in the field of neurosurgery and offer new educational possibilities for young neurosurgery and medical students.

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Author and article information

Journal

Journal ID (nlm-ta): Neurosurg Focus Video

Journal ID (iso-abbrev): Neurosurg Focus Video

Journal ID (publisher-id): Neurosurg Focus Video

Title: Neurosurgical Focus: Video

Publisher: American Association of Neurological Surgeons

ISSN (Electronic): 2643-5217

Publication date Collection: January 2024

Publication date (Electronic): 01 January 2024

Volume: 10

Issue: 1 , Use of the Exoscope in Neurosurgery

Electronic Location Identifier: V18

Affiliations

[1]Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah

Author notes

Correspondence Mark A. Mahan: University of Utah, Salt Lake City, UT. neuropub@ 123456hsc.utah.edu .

INCLUDE WHEN CITING DOI: 10.3171/2023.10.FOCVID23162.

Disclosures Dr. Mahan reported personal fees from joimax and Renerva, and grants from Boston Scientific, Orthofix, and Nevro, outside the submitted work.

Article

Publisher ID: 2023.10.FOCVID23162

DOI: 10.3171/2023.10.FOCVID23162

PMC ID: 10821651

PubMed ID: 38283809

SO-VID: c1a01fea-0aae-426a-80c8-af6193b4bf9a

License:

This is an open access article distributed under the CC BY license ( http://creativecommons.org/licenses/by/4.0/).

History

Date received : 21 August 2023

Date accepted : 20 October 2023

Page count

Figures: 0, Tables: 0, References: 9, Pages: 2

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