3D Exoscope-Assisted Microvascular Anastomosis: An Evaluation on Latex Vessel Models

Background. Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical field: microsurgical procedures can be performed with the aid of this instrument. Here, we describe our preliminary experience with a high-definition 3D exoscope (VITOM(®), Karl Storz, Tuttlingen, Germany), evaluating the characteristics of the instrument, and also its use as a magnification device for microanastomosis training. Methods. Six microsurgeons with various levels of experience were asked to perform three end-to-end anastomoses and two end-to-side anastomoses on latex vessel models, using, as a magnification system, the VITOM(®) 3D 4K exoscope. None of the surgeons involved had previous experience with the exoscope, with robotic surgery, with endoscopic surgery, nor with training simulators. Results. The results of the reported evaluation of the tool’s qualities, (VITOM Quality Assessment Tool) included: a good focusing of the surgical field; high image quality; strong luminance; good magnification; clear stereoscopy; and excellent freedom of movement. The exoscope proved to be user-friendly. A constant reduction in the time needed to perform the microsurgical anastomosis at each exercise was recorded. Among other advantages were the easy switching from the magnified image to the macroscopic view, superior ergonomics allowing a relaxed posture while performing the anastomosis, adequate space, and a convenient setting for the assistants to view the operating field. Conclusions. Our study showed that the exoscope VITOM 3D can be successfully used as a magnification tool for microsurgical anastomosis on synthetic vessels, and that it can also be helpful during training courses in microsurgery.