Neurosurgery requires an operating microscope. Since the 1960s, operating microscopes that allow you to look through a lens have been used in neurosurgery for over half a century.

In the 2010s, a new surgical microscope system called an "exoscopic" was developed. In exoscopic surgery, rather than looking through a lens, surgery is performed while viewing images magnified by a video camera on a large 3D monitor, just like with an endoscope. Many surgeons who have used an exoscopic system feel that it is "superior to conventional surgical microscopes" in various aspects, such as image resolution and brightness, the burden on the surgeon, and surgeon education. However, due to a lack of objective data, these opinions have remained limited to their own impressions of using the system.

Our hospital was one of the first in Japan to introduce exoscopic surgery, and we compared the features of exoscopic surgery with those of conventional surgical microscopes in a surgery called microvascular decompression, which we frequently perform at our hospital.

The results showed that exoscopic microscopes are superior to conventional surgical microscopes in terms of image resolution, brightness, color, field of view, surgeon workload, and surgeon education. In particular, even surgeons with extensive experience using surgical microscopes confirmed that exoscopic microscopes are superior in operability and reduced surgeon workload.

The exoscope's excellent performance, which improves operability and reduces fatigue for the surgeon, also contributes to improving the safety of surgery. Therefore, our hospital has installed another exoscope, and all scheduled neurosurgery surgeries are now performed using an exoscope.

The Department of Neurosurgery will continue to not only introduce cutting-edge medical technology, but also evaluate its usefulness and strive to improve the safety of the treatments available to patients.

Surgery using an exoscopic endoscope

• Functionality and Usability of the Exoscope in Microvascular Decompression for Hemifacial Spasm and Trigeminal Neuralgia – World Neurosurgery. 2023 Sep 6

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