Evaluating the Use of a 3D Exoscope to Improve Ergonomics in Cleft Surgery

<i>Objective</i>The aim of this study was to investigate and compare the technical feasibility, ergonomics, and educational value of the 3D exoscope in comparison with traditional and prism loupes in cleft surgery.<i>Design</i>A variety of cleft and pharyngeal operations were performed with the VITOM^® 3D exoscope (Karl Storz GmbH, Tuttlingen, Germany), traditional/prism loupes, and microscope. The cervical neck angulation of the operating surgeon was recorded in real-time with an inertia measurement unit system (Mbient, San Francisco, USA) and experiences of the surgeon and assistant were prospectively evaluated with 5-point Likert scales.<i>Setting</i>National Health Service, England.<i>Patients, Participants</i>Eleven patients were recruited in whom 12 procedures were performed. Two main surgeons, 3 assistant surgeons, and 3 scrub nurses were recruited into the study.<i>Interventions</i>Four procedures were performed with the VITOM^® 3D exoscope, and as the comparison groups, 5 procedures were performed with normal loupes, 3 with prism loupes, and 2 were done in combination with a microscope and analyzed separately.<i>Main Outcome Measure(s)</i>Neck angle measurements and feedback from surgeons, assistants, and scrub nurses.<i>Results</i>The VITOM^® system improved surgeon ergonomics with reduced procedure time in cervical flexion when compared to the other visualization methods (versus loupes, <i>P</i> < .01, and prism, <i>P</i> < .01). The VITOM^® system also scored favorably in terms of image-related fields, ergonomics, and ease of use.<i>Conclusion</i>Use of the 3D exoscope in cleft surgery yielded improved experiences for both surgeons, assistants, and nurses in comparison with loupes and microscopes without increasing operating time.