Expanding Access to Microneurosurgery in Low-Resource Settings: Feasibility of a Low-Cost Exoscope in Transforaminal Lumbar Interbody Fusion

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Expanding Access to Microneurosurgery in Low-Resource Settings: Feasibility of a Low-Cost Exoscope in Transforaminal Lumbar Interbody Fusion


JournalJournal of Neurosciences in Rural Practice
Article typeJournal research article – Clinical research
Publication date – Jul – 2022
Authors – Manuel De Jesus Encarnacion Ramirez, Ismael Peralta , Renat Nurmukhametov, Rossi Evelyn Barrientos Castillo , Juan Sebastian Castro, Alexander Volovich, Medet Dosanov, Ibrahim E. Efe 
Keywordsexoscope, low cost, Neurosurgery, spine surgery, surgical field
Open access – Yes
SpecialityNeurosurgery, Trauma and orthopaedic surgery
World region Global

Language – English
Submitted to the One Surgery Index on August 1, 2022 at 10:06 pm
Abstract:

Objectives Less than a quarter of the world population has access to microneurosurgical care within a range of 2 hours. We introduce a simplified exoscopic visualization system to achieve optical magnification, illumination, and video recording in low-resource settings.

Materials and Methods We purchased a 48 megapixels industrial microscope camera with a heavy-duty support arm, a wide field c-mount lens, and an LED ring light at a total cost of US$ 125. Sixteen patients with lumbar degenerative disk disease were divided into an exoscope group and a conventional microscope group. In each group we performed four open and four minimally invasive transforaminal lumbar interbody fusion procedures. We further conducted a questionnaire-based assessment of the user experience.

Results The overall user experience was positive. The exoscope achieved similar postoperative improvement with comparable blood loss and operating time as the conventional microscope. It provided a similar image quality, magnification and illumination. Yet, the lack of stereoscopic perception and the cumbersome adjustability of the camera position and angle resulted in a shallow learning curve. Most users strongly agreed that the exoscope would significantly improve surgical teaching. Over 75% reported they would recommend the exoscope to colleagues and all users saw its great potential for low-resource environments.

Conclusion Our low-budget exoscope is technically non-inferior to the conventional binocular microscope and purchasable at a significantly lower price. It may thus help expand access to neurosurgical care and training worldwide.

OSI Number – 21691

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