Airborne particle dynamics during draping of a surgical microscope versus an exoscope in spinal surgery: A prospective comparative study

Background: Exoscopes provide ergonomic and visualization advantages over conventional surgical microscopes. Despite their growing adoption, the impact of device draping on transient airborne particulate generation during setup, a critical but understudied contributor to surgical site contamination, remains unclear. Methods: This prospective observational study compared airborne particle dynamics during draping of a surgical microscope (Pentero) and an exoscope (Orbeye) in ten spinal surgeries (five per group) conducted in a laminar airflow operating room with high-efficiency particulate air filtration. Airborne particles sized 0.5 μm and 1.0 μm were recorded at 5 s intervals for 1 min from drape initiation. Cumulative exposure was analyzed using the area under the curve (AUC), and temporal dispersion patterns were analyzed using linear mixed-effects models. Results: Cumulative airborne particle exposure did not differ significantly between devices for either 0.5 μm or 1.0 μm particles, although 0.5 μm AUC values tended to be lower with the exoscope. Time-resolved analysis demonstrated a significant time-by-device interaction for 0.5 μm particles ( p = 0.039), with lower particle counts observed with the exoscope at drape initiation. This device-dependent transient behavior was not observed for larger particles (1.0 μm). Conclusion: Transient airborne particle behavior during draping appears to be influenced by device configuration and draping mechanics rather than cumulative exposure alone. Awareness of device-specific airflow interactions and controlled draping practices may help mitigate transient contamination risk and enhance intraoperative environmental safety.