Beyond Magnification and Illumination: Ergonomics with a 3D Exoscope in Lumbar Spine Microsurgery to Reduce Musculoskeletal Injuries

OBJECTIVE: The risk of musculoskeletal injuries (MSIs) increases over years of practice which may lead to career‐ending among surgeons. Exoscopes represent a new generation of imaging systems that help surgeons operate in a more comfortable posture. This article aimed to assess advantages and limitations, especially ergonomics with a 3D exoscope in lumbar spine microsurgery versus an operating microscope (OM) to reduce MSIs. METHODS: From March 2018 to May 2020, 90 patients with lumbar disc herniation undergoing a single‐level minimally invasive transforaminal lumbar interbody fusion (MIS‐TLIF) procedure were included. Forty‐seven patients were operated with the assistance of the exoscope and 43 patients were operated with the assistance of the OM. Clinical data, magnification, and illumination were evaluated. In particular, the ergonomics of surgeons was evaluated by a questionnaire (subjective) and a rapid entire body assessment (REBA; objective). RESULTS: The postoperative outcomes were reasonably well balanced between the two groups. The handling of the exoscope was comparable to that of the OM. The depth perception, image quality, and illumination of the exoscope were inferior to those of the OM in MIS‐TLIF with long and deep approaches. The educational and training function of the exoscope was superior to that of the OM. Importantly, surgeons rated the ergonomics of the exoscope as very high on the questionnaire and the REBA to the OM (P = 0.017). CONCLUSIONS: This study showed that the exoscope was a safe and effective alternative to the OM for assisting the MIS‐TLIF procedure with the unique advantage of ergonomics to reduce musculoskeletal injuries.