Introduction: We have previously reported on the development and pre-clinical assessment of a novel, three-dimensional (3D), high-definition (4K-HD) exoscope system that provides an immersive surgical experience with a portable, low profile design.

Methods: The operative workflow, functionality, and visual haptics of the 3D 4K-HD exoscope were assessed during its first-in-man surgical use to for vascular microneurosurgery.

Results: Five microneurosurgical cases (on four patients) were performed exclusively using the 3D 4K-HD exoscope. Pathologies treated included two aneurysms, two cavernous malformations, and one arteriovenous malformation. All patients experienced good surgical and clinical outcomes. An intra-operative aneurysm rupture in one case was managed routinely. Similar to pre-clinical assessments, the 3D 4K-HD exoscope provided an immersive three-dimensional surgical experience for the primary surgeon, assistants, and trainees. The small excoscope frame, large depth of field, and hand/foot pedal controls improved exoscope mobility, decreased need to re-focus, and provided unobstructed operative corridors. Flexible positioning of the camera and visual projections kept the surgeon in an ergonomically advantageous position with a horizontal gaze across multiple operative angles.

Conclusions: The first-in-man clinical experience with the 3D 4K-HD exoscope confirms its excellent optics and ergonomics for the entire operative team, with high workflow adaptability for vascular microneurosurgical cases. Expanded clinical use of the 3D 4K-HD exoscope is justified.

Patient Care: The 3D 4K-HD exoscope provides a novel surgical tool for complex intracranial operations.

Learning Objectives: Learn the clinical potential of the 3D 4K-HD exoscope for vascular microneurosurgery.

References: Sack J, Steinberg JA, Rennert RC, et al. Initial Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery. Oper Neurosurg. 2017; opx145, https://doi.org/10.1093/ons/opx145