Exoscope neurosurgery

In the 1950s, “the surgical microscope entered the neurosurgical operating room … at the University of Southern California,” notes a 2009 article in the Journal of Neurosurgery. More than 60 years later, the operating microscope is the 2-D gold standard for brain and spine procedures.

The 2-D operating microscope for microneurosurgery assists surgeons with enhanced perception of the surgical field. The technology typically includes a second site where a medical student or operating team member can peer into the brain.

According to Dr. Michael Schulder, M.D., a neurosurgeon with North Shore University Hospital in Manhasset, N.Y., the view from the additional site is almost as good as the surgeon’s.

But while the 2-D microscope is impressive, the new 3-D robotic exoscopes for exoscope neurosurgery offer stiff competition.

In the Journal of the Korean Neurosurgical Society in 2017, Kenichi Nishiyama, M.D., Ph.D., describes 3-D exoscopes as this: “A high-definition video telescope and operating monitor system for performing microsurgery…(that) enables surgeons to complete the operation by visualizing magnified images on a display. The strong points of an exoscope are the broad field of view and deep focus. It minimizes the need for repositioning and refocusing the scope during the procedure.”

The Modus V 3D robotic digital exoscope from Synaptive Medical offers one example of the new medical technology’s range of abilities.

The technology up close

According to Kyle D’Arcey, director of product management for Synaptive Medical, the Modus V 3D robotic exoscope moves in sync with the procedure, tracking a co-axial view of the surgical instruments.

The exoscope’s advanced optics and video processing allow it to render high-quality HD video images of the surgical field on a computer monitor. The exoscopic visualization gives surgeons depth perception and surgical views with a 12.5-times optical zoom.

The Modus V proves easy on the surgeon’s spine, enabling them to operate heads-up, viewing the monitor. It also uses voice activation to control all system settings, including motion.

Comparing the Modus V with 2-D Operating Microscopes

Michael Schulder, M.D., is vice chair of neurosurgery and director of the Brain Tumor Center at North Shore University Hospital. On August 6, 2020, Schulder was reported as the first surgeon on Long Island to use Synaptive’s Modus V 3-D exoscope to remove a brain tumor.

As Schulder describes it, the surgeon and anyone within the computer monitor’s range can see what the exoscope sees in three dimensions in high resolution.

“The surgical staff and anesthesiologists all see the same thing. Your scrub nurse, your circulating nurse, they’re all much more a part of the procedure as a result of using the exoscope,” says Schulder. There are advantages for medical education, says Schulder; residents, surgeons, medical students and trainees can see what’s happening.

The Modus V 3D images serve as safeguards. According to Schulder, the Modus V helps ensure that the assisting surgeon’s hands aren’t going astray, so the surgeon doesn’t have to constantly tell them to be careful. It’s much easier to avoid reaching too deeply when both surgeons see the procedure in three dimensions, Schulder adds.

The Modus V makes Schulder’s work easier. “Ergonomically, you can stand or sit and look straight ahead during the operation, viewing everything on the monitor. It’s a much more natural, comfortable position, and you’re not constrained by the visual requirements of the operating microscope,” says Schulder.

Schulder suggests some qualitative observations of the Modus V:

You’ll probably have fewer hemostasis problems, he notes, and less risk of hematoma formation because you have two people working together. The surgery could be less invasive as surgeons can look down toward the targets in the brain and operate without having to have broad exposure to the brain.

Good nerve tracing makes for excellent surgical planning. The synaptic scope and the integrated stereotactic navigation with geographical white matter tracking are pretty enabling, according to Schulder.

“You can trace out brain nerve fibers and plan a surgical approach that avoids injury to critical nerve pathways for control, sensation or efficient speech,” he says.

Favorite features and wish list

According to Schulder, voice activation is a favorite Modus V feature because it lets the surgeon guide the movements of the exoscope using straightforward and intuitive voice commands. The surgeon can zoom in and out and change the lighting while keeping their hands in the surgical field, says Schulder.

Schulder hopes to see advances in the Modus V related to surgical visualization technology. Surgical visualization injects fluorescent substances into the bloodstream, highlighting tumors, cerebral spinal fluids, and blood vessels. Successful surgical microscopes take advantage of surgical visualization. Modus V needs this functionality, according to Schulder.

For more information

See the Modus V product page for more information. Use the contact page to reach the vendor for pricing. According to D’Arcey, the Modus V price is comparable with that of a conventional surgical microscope.