Learning neuroendoscopy with an exoscope system (video telescopic operating monitor): Early clinical results

Abstract

Context: Steep learning curve is found initially in pure endoscopic procedures. Video telescopic operating monitor (VITOM) is an advance in rigid-lens telescope systems provides an alternative method for learning basics of neuroendoscopy with the help of the familiar principle of microneurosurgery.

Aims: The aim was to evaluate the clinical utility of VITOM as a learning tool for neuroendoscopy.

Materials and methods: Video telescopic operating monitor was used 39 cranial and spinal procedures and its utility as a tool for minimally invasive neurosurgery and neuroendoscopy for initial learning curve was studied.

Results: Video telescopic operating monitor was used in 25 cranial and 14 spinal procedures. Image quality is comparable to endoscope and microscope. Surgeons comfort improved with VITOM. Frequent repositioning of scope holder and lack of stereopsis is initial limiting factor was compensated for with repeated procedures.

Conclusions: Video telescopic operating monitor is found useful to reduce initial learning curve of neuroendoscopy.

Keywords: Exoscope; neuroendoscopy; video telescopic operating monitor.

Figure 1

Video telescopic operating monitor positioning and set up

Figure 2

Preoperative coronal T1-weighted contrast magnetic resonance imaging showing colloid cyst (a) and postoperative computed tomography scan reveal complete excision (b), Intraoperative video telescopic operating monitor view of cyst decompression (c) and excision (d)

Figure 3

Preoperative axial T1-weighted contrast magnetic resonance imaging showing left cerebellopontine (CP) angle tumor (a), postoperative contrast computed tomography scan reveal complete removal of tumor (b), Intraoperative video telescopic operating monitor view of CP angle (c), tumor debulking (d), separation from brain stem (e) and after tumor removal and anatomical preservation of facial nerve (f)

Figure 4

Preoperative T2-weighted sagittal (a) and axial (b) magnetic resonance imaging showing L5-S1 disc, Intraoperative video telescopic operating monitor view of removing lamina (c), and disc (d)

Figure 5

Preoperative axial T1-weighted contrast magnetic resonance imaging (MRI) showing C2-3 intra-extradural tumor (a), postoperative T2-weighted axial MRI reveal complete removal of tumor (b), Intraoperative video telescopic operating monitor view of removing C2 lamina (c), extradural component removal (d), intradural assessment (e) and dural closure (f)