Exoscopic carotid endarterectomy using movable 4K 3D monitor: Technical note

BACKGROUND: Carotid endarterectomy (CEA) using conventional surgical microscope has been already established as golden standard. Recently, exoscope was introduced into the field of neurosurgery, and various merits of it have been reported. We report the experiences of exoscopic CEA using a movable 4K 3D monitor and discuss the feasibility of it. METHODS: We report a consecutive series of 15 cases of exoscopic CEA for internal carotid artery (ICA) stenosis using a movable 4K 3D monitor between January 2020 and April 2021. We utilized ORBEYE as an exoscope system and a 31-inch movable 4K 3D monitor, which was installed in the Maquet Moduevo ceiling supply unit. RESULTS: In all 15 cases, the procedures were accomplished only using the ORBEYE. There were no operative complications due to the use of the exoscope. In response to the operative site, the 4K 3D monitor was moved to face the operator. Even when the angle of the visual axis of the exoscope against the horizontal plane was small during the surgical manipulation in the distal portion of ICA, the operator was able to maintain a comfortable posture. CONCLUSION: Using the movable 4K 3D monitor, exoscopic CEA can be performed ergonomically. The operator can manipulate the distal portion of the ICA or proximal portion of the common carotid artery in a comfortable posture and face the monitor by adjusting its position.