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

Archives of Plastic Surgery 2020년 47권 3호 p.242 ~ 249
Pafitanis Georgios, Hadjiandreou Michalis, Alamri Alexander, Uff Christopher, Walsh Daniel, Myers Simon,
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 ( Pafitanis Georgios ) - Great Ormond Street Hospital for Children Foundation Trust Department of Plastic Surgery
 ( Hadjiandreou Michalis ) - Barts and The London School of Medicine and Dentistry
 ( Alamri Alexander ) - Barts Health NHS Trust Royal London Hospital Department of Neurosurgery
 ( Uff Christopher ) - Barts Health NHS Trust Royal London Hospital Department of Neurosurgery
 ( Walsh Daniel ) - King’s College Hospital Department of Neurosurgery
 ( Myers Simon ) - Barts Health NHS Trust Royal London Hospital Department of Neurosurgery

Abstract


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.

키워드

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

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