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CC BY-NC 4.0 · Arch Plast Surg 2020; 47(03): 242-249
DOI: 10.5999/aps.2019.01473
Original Article

The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial

Georgios Pafitanis 
Group for Academic Plastic Surgery, Microvascular Anastomosis Simulation Hub, The Blizard Institute, Queen Mary University of London, London, UK
Department of Plastic Surgery, Great Ormond Street Hospital for Children Foundation Trust, London, UK
Barts’ and The London School of Medicine and Dentistry, London, UK
,
Michalis Hadjiandreou 
Barts’ and The London School of Medicine and Dentistry, London, UK
,
Alexander Alamri
Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
,
Christopher Uff
Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
,
Daniel Walsh
Department of Neurosurgery, King’s College Hospital, London, UK
,
Simon Myers
Group for Academic Plastic Surgery, Microvascular Anastomosis Simulation Hub, The Blizard Institute, Queen Mary University of London, London, UK
Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Background The Exoscope is a novel high-definition digital camera system. There is limited evidence signifying the use of exoscopic devices in microsurgery. This trial objectively assesses the effects of the use of the Exoscope as an alternative to the standard operating microscope (OM) on the performance of experts in a simulated microvascular anastomosis.

Methods Modus V Exoscope and OM were used by expert microsurgeons to perform standardized tasks. Hand-motion analyzer measured the total pathlength (TP), total movements (TM), total time (TT), and quality of end-product anastomosis. A clinical margin of TT was performed to prove non-inferiority. An expert performed consecutive microvascular anastomoses to provide the exoscopic learning curve until reached plateau in TT.

Results Ten micro sutures and 10 anastomoses were performed. Analysis demonstrated statistically significant differences in performing micro sutures for TP, TM, and TT. There was statistical significance in TM and TT, however, marginal non-significant difference in TP regarding microvascular anastomoses performance. The intimal suture line analysis demonstrated no statistically significant differences. Non-inferiority results based on clinical inferiority margin (Δ) of TT=10 minutes demonstrated an absolute difference of 0.07 minutes between OM and Exoscope cohorts. A 51%, 58%, and 46% improvement or reduction was achieved in TT, TM, TP, respectively, during the exoscopic microvascular anastomosis learning curve.

Conclusions This study demonstrated that experts’ Exoscope anastomoses appear non-inferior to the OM anastomoses. Exoscopic microvascular anastomosis was more time consuming but end-product (patency) in not clinically inferior. Experts’ “warm-up” learning curve is steep but swift and may prove to reach clinical equality.

Keywords

Exoscope - Video telescope operating monitor - Microsurgery - Microscopy - Microvascular anastomosis

The authors would like to express their appreciation to Ian Weighell and Chris Fell from Synaptive Medical Inc., for their contribution in providing the Modus V device.




Publication History

Received: 13 October 2019

Accepted: 02 April 2020

Article published online:
22 March 2022

© 2020. 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-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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