Evaluation of a video telescopic operating microscope (VITOM) for pediatric surgery and urology: a preliminary report

Abstract

Introduction: Optical magnification is an essential tool in the practice of pediatric surgery. Magnifying loupes are the most frequently used instrument, although their use often comes at the expense of neck pain experienced by the operating surgeon. Recent advances have led to the development of a compact video microscope (VITOM(®); Karl Storz Endoscopy GmbH, Tuttlingen, Germany) that displays high-definition magnified images on a flat screen. This study was designed to evaluate VITOM as a potential substitute for loupes in complex open pediatric procedures and to explore VITOM as an effective intraoperative teaching modality for open surgery.

Subjects and methods: Three surgeons used the VITOM II exoscope in 20 operations: 14 hypospadias repairs, 2 inguinal hernia repairs, 1 sacrococcygeal teratoma resection, 1 recurrent tracheoesophageal fistula repair, and 2 additional procedures. Surgeons, trainees, and surgical technicians subjectively evaluated image quality; surgeons evaluated handling of VITOM, degree of neck strain, and fatigue. Three midlevel surgical trainees assessed the VITOM potential for teaching value. Overall impressions of each group and consensus opinions were generated.

Results: All procedures were completed without complication. The consensus opinion of the entire group was that image quality was excellent. The surgeons found VITOM easy to use, and all agreed that neck strain and fatigue were reduced. Surgical trainees felt that VITOM imaging aided in their understanding of procedures and anatomy. Surgical technicians perceived improved operation flow through better visualization of the procedure.

Conclusions: VITOM provides excellent visualization of pediatric operations with improved surgeon comfort and may serve as a substitute for loupes. Secondarily, we found enhanced trainee learning and potential improvement in the flow of surgical procedures. Further study of VITOM with a larger sample size and validated tools is needed.

FIG. 1.

The VITOM II exoscope. (A) VITOM II with Image 1 H3-Z high-definition camera and articulating stand. (B) Operating room set-up of VITOM II with 26-inch flat screen monitor.

FIG. 2.

VITOM images of hypospadias repair: (A) elevation of the urethral plate to correct severe chordee; (B) extended urethroplasty with tubularization of the urethral plate; (C) completed urethroplasty; and (D) circumcision skin closure.

FIG. 3.

VITOM images of a newborn with a type I sacrococcygeal teratoma (SCT) resection: (A) SCT prior to resection; (B) division of the sacrococcygeal joint, taking the coccyx en bloc with the tumor; (C) dissection of the tumor (T) from the posterior rectal wall noted by arrow; and (D) pelvic floor reconstruction suturing the posterior levator muscles to the presacral fascia.