(A547) Exoscope Use in Head and Neck Reconstructive Surgery, First Impressions

Introduction: The exoscope aims to improve microscopic detail and quality improve physician comfort during microscopic surgery. The aim of this study was to describe the benefits and disadvantages of using an exoscope during head and neck microvascular surgery.

Methods: All head and neck microvascular surgeries in which an exoscope was used at a single institution were included in this study. The exoscope used in this study was the Mikata HawkSight 4K3D exoscope. The exoscope was used during preparation of flap and neck vessels, arterial anastomosis, and venous anastomosis. Operating surgeons were asked to relay if the experience was positive or negative, if there was improved or worsened comfort compared to standard microscopy, and if the surgeon was likely or unlikely to use the exoscope in the future. Perception of attractive features and drawbacks were gathered as well.

Results: The exoscope was used in 12 head and neck reconstructive surgeries. Surgeons perceived the experience of using the exoscope as positive, reported increased comfort, and were likely to use the exoscope in the future in all 12 surgeries. Attractive features were the ability for the entire surgical team to benefit from three-dimensional image quality, improved surgical ergonomics, ease of use, less cluttered surgical field, increased surgeon freedom of motion, increased imaging angle maneuverability, and high-quality imaging. The main drawback that was observed was that decreased picture brightness compared to standard microscopy. The other reported drawback was the need for multiple monitors in the operating room.

Conclusions: Initial use of the exoscope in head & neck microvascular surgery was met with a positive perception from all surgeons involved. The advantages observed are mostly related with physician ergonomics and comfort during surgery. Future improvements in technology will possibly address the observed drawbacks encountered during our study. Future studies focused on length of surgery, future developments, surgical outcomes, and physician fatigue during microvascular surgery will help determine the best uses for the exoscope.