Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial

  • Pafitanis, Georgios (Group for Academic Plastic Surgery, Microvascular Anastomosis Simulation Hub, The Blizard Institute, Queen Mary University of London) ;
  • Hadjiandreou, Michalis (Barts' and The London School of Medicine and Dentistry) ;
  • Alamri, Alexander (Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust) ;
  • Uff, Christopher (Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust) ;
  • Walsh, Daniel (Department of Neurosurgery, King's College Hospital) ;
  • Myers, Simon (Group for Academic Plastic Surgery, Microvascular Anastomosis Simulation Hub, The Blizard Institute, Queen Mary University of London)
  • Received : 2019.10.13
  • Accepted : 2020.04.02
  • Published : 2020.05.15
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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.

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References

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