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. 2023 Jan-Mar;14(1):156-160.
doi: 10.25259/JNRP-2022-3-13. Epub 2022 Dec 22.

Expanding access to microneurosurgery in low-resource settings: Feasibility of a low-cost exoscope in transforaminal lumbar interbody fusion

Manuel Encarnacion Ramirez  1 , Ismael Peralta  2 , Renat Nurmukhametov  1 , Rossi Evelyn Barrientos Castillo  1 , Juan Sebastian Castro  3 , Alexander Volovich  3 , Medet Dosanov  3 , Ibrahim E Efe  4
Affiliations

Expanding access to microneurosurgery in low-resource settings: Feasibility of a low-cost exoscope in transforaminal lumbar interbody fusion

Manuel Encarnacion Ramirez et al. J Neurosci Rural Pract. 2023 Jan-Mar.

Abstract

Objectives: Less than a quarter of the world population has access to microneurosurgical care within a range of 2 h. We introduce a simplified exoscopic visualization system for low-resource settings.

Materials and methods: We purchased a 48 megapixels microscope camera with a c-mount lens and a ring light at a total cost of US$ 125. Sixteen patients with lumbar degenerative disk disease were divided into an exoscope group and a microscope group. In each group, we performed four open and four minimally invasive transforaminal lumbar interbody fusions (TLIF). We conducted a questionnaire-based assessment of the user experience.

Results: The exoscope achieved similar outcomes with comparable blood loss and operating time as the microscope. It provided similar image quality and magnification. Yet, it lacked stereoscopic perception and the adjustability of the camera position was cumbersome. Most users strongly agreed the exoscope would significantly improve surgical teaching. Over 75% reported that they would recommend the exoscope to colleagues and all users saw its great potential for low-resource environments.

Conclusion: Our low-budget exoscope is safe and feasible for TLIF and purchasable at a fraction of the cost of conventional microscopes. It may thus help expand access to neurosurgical care and training worldwide.

Keywords: Exoscope; Global neurosurgery; Low cost; Spine surgery; Surgical ergonomics.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
The fully assembled low-budget exoscope (a) composed of video microscope camera, C-mount lens, LED ring light, and cantilever. Intraoperative setup (b) with camera pointing at tubular retractor in a minimally invasive transforaminal lumbar interbody fusion (TLIF) procedure. The surgical field of an open TLIF (c) and a minimally invasive TLIF (d) as projected on the television screen.
Figure 2:
Figure 2:
Results of the digital questionnaire-based usability assessment.
See this image and copyright information in PMC

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