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A Systematic Review of Exoscope Application in Spinal Procedures Publisher



Lapevandani MM1 ; Kankam SB2, 3 ; Haidershah A4 ; Eraghi MM5, 6 ; Habibzadeh A7 ; Liang YH8 ; Farahbakhsh F3 ; Jalloh M2, 3 ; Osifala O9
Authors
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Authors Affiliations
  1. 1. Multiple Sclerosis Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, United States
  3. 3. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. School of Medicine, Islamic Azad University, Qeshm International Branch, Qeshm, Iran
  7. 7. Fasa University of Medical Sciences, Fasa, Iran
  8. 8. Harvard T.H. Chan School of Public Health, Harvard University, United States
  9. 9. Harvard T.H Chan School of Public Health, Harvard University, Cambridge, United States

Source: International Journal of Surgery Open Published:2025


Abstract

Objective: This study aimed to assess the utility of the exoscope (EX) system in spine surgeries in comparison to the operating microscope (OM). Methods: The authors searched MEDLINE and Scopus until September 2023 to review common spinal surgeries with the EX-system, documenting procedures, surgery-related experiences, and outcomes. Results: We identified 35 articles that included 492 cases of EX-based spine surgeries. The most frequent procedures performed using the EX-system were discectomy, fusion, decompression, and tumor resection. Of the 35 articles, 25 (71%) reported using a 3D HD EX-system, with 5 employing a 4 K resolution monitor. Regarding video image quality, 19 articles (63%) found EX-system outcomes to be superior to OM, while six (17%) rated the quality on par with OM, and five articles (14%) deemed it inferior. Regarding surgical field visibility with the EX-system, 19 studies (70%) reported a superior experience, five studies (18%) found it similar to OM, and three reported it inferior. Regarding handling, 21 studies (87%) indicated easier management compared to OM. Twelve articles (52%) expressed a negative view on depth-perception with the EX-system, seven (33%) rated it as superior, and two (14%) found it comparable to OM. Out of 29 articles discussing surgical ergonomics, 28 reported a satisfactory experience with the EX-system, and one found it comparable to OM. Conclusion: The EX-system provides adequate visualization, depth perception and is useful for training surgical assistants in spinal procedures. However, evidence of its superiority to traditional OM remains limited, necessitating further research to ascertain its clinical and surgical effectiveness. Copyright © 2025 The Authors.
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