Exoscope and Supermicrosurgery: Pros and Cons of 3D Innovation in Lymphatic Surgery
Abstract
:1. Introduction
1.1. Surgical Treatment of Lymphedema
1.2. The 3D Exoscopes
1.3. Aim of the Study
2. Materials and Methods
2.1. Study Design and Setting
2.2. Patients
2.3. Surgical Procedure
2.4. Ergonomic Evaluation and Survey
2.5. Statistical Analysis
3. Results
3.1. Retrospective Series and OM–Exoscope Comparison
3.2. Ergonomic Evaluation and Survey of Surgeons
3.3. Follow-Up at 1 Month
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Yamamoto, T.; Yamamoto, N.; Kageyama, T.; Sakai, H.; Fuse, Y.; Tsuihiji, K.; Tsukuura, R. Technical pearls in lymphatic supermicrosurgery. Glob. Health Med. 2020, 2, 29–32. [Google Scholar] [CrossRef]
- Masia, J.; Olivares, L.; Koshima, I.; Teo, T.C.; Suominen, S.; Van Landuyt, K.; Demirtas, Y.; Becker, C.; Pons, G.; Garusi, C.; et al. Barcelona consensus on supermicrosurgery. J. Reconstr. Microsurg. 2014, 30, 53–58. [Google Scholar] [CrossRef] [PubMed]
- Scaglioni, M.F.; Meroni, M.; Fritsche, E.; Linder, T.; Rajan, G. Use of the BHS robotic scope to perform lymphovenous anastomosis. Microsurgery 2021, 41, 298–299. [Google Scholar] [CrossRef] [PubMed]
- Fiani, B.; Jarrah, R.; Griepp, D.W.; Adukuzhiyil, J. The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation. Cureus 2021, 13, e15878. [Google Scholar] [CrossRef]
- Garcia, J.P.; Avila, F.R.; Torres, R.A.; Maita, K.C.; Borna, S.; Rinker, B.D.; Forte, A.J.; Ho, O.A. Evaluating the exoscope as an alternative to the operating microscope in plastic surgery. J. Plast. Reconstr. Aesthetic Surg. JPRAS 2023, 85, 376–386. [Google Scholar] [CrossRef]
- Gaffuri, M.; di Lullo, A.M.; Trecca, E.M.C.; Russo, G.; Molinari, G.; Russo, F.Y.; Albera, A.; Mannelli, G.; Ralli, M.; Turri-Zanoni, M. High-Definition 3D Exoscope in Pediatric Otorhinolaryngology: A Systematic Literature Review. J. Clin. Med. 2023, 12, 6528. [Google Scholar] [CrossRef]
- Garneau, J.C.; Laitman, B.M.; Cosetti, M.K.; Hadjipanayis, C.; Wanna, G. The Use of the Exoscope in Lateral Skull Base Surgery: Advantages and Limitations. Otol. Neurotol. 2019, 40, 236–240. [Google Scholar] [CrossRef]
- Gabriele, G.; Nigri, A.; Chisci, G.; Massarelli, O.; Cascino, F.; Komorowska-Timek, E.; Kazuki, K.; Hara, H.; Mihara, M.; Gennaro, P. Combination of Supramicrosurgical Lymphatico-Venular Anastomosis (sLVA) and Lymph-Sparing Liposuction in Treating Cancer-Related Lymphedema: Rationale for a Regional One-Stage Approach. J. Clin. Med. 2024, 13, 2872. [Google Scholar] [CrossRef]
- Dwyer, A.; Huckleby, J.; Kabbani, M.; Delano, A.; De Sutter, M.; Crawford, D. Ergonomic Assessment of Robotic General Surgeons: A Pilot Study. J. Robot. Surg. 2020, 14, 387–392. [Google Scholar] [CrossRef]
- Keric, N.; Krenzlin, H.; Kurz, E.; Wesp, D.M.A.; Kalasauskas, D.; Ringel, F. Evaluation of 3D Robotic-Guided Exoscopic Visualization in Microneurosurgery. Front. Surg. 2022, 8, 791427. [Google Scholar] [CrossRef]
- The Jamovi Project (2024). Jamovi (Version 2.5) [MacOs Lion10.7]. Available online: https://www.jamovi.org (accessed on 22 May 2024).
- R Core Team. R (Version 4.3.1) [MacOs Lion10.7]. R: A Language and Environment for Statistical Computing_; R Foundation for Statistical Computing: Vienna, Austria, 2023; Available online: https://www.R-project.org. (accessed on 20 August 2024).
- Chen, W.F. How to Get Started Performing Supermicrosurgical Lymphaticovenular Anastomosis to Treat Lymphedema. Ann. Plast. Surg. 2018, 81 (Suppl. S1), S15–S20. [Google Scholar] [CrossRef]
- Gennaro, P.; Gabriele, G.; Salini, C.; Chisci, G.; Cascino, F.; Xu, J.F.; Ungari, C. Our Supramicrosurgical Experience of Lymphaticovenular Anastomosis in Lymphoedema Patients to Prevent Cellulitis. Eur. Rev. Med. Pharmacol. Sci. 2017, 21, 674–679. [Google Scholar] [PubMed]
- Bordianu, A.; Petre, I.; Bobircă, A.; Bobircă, F. The Vascularized Omentum Lymph Node Transfer—A Key Point in the Lymphedema Management. Chirurgia 2024, 119, 191–200. [Google Scholar] [CrossRef]
- Pak, C.S.; Suh, H.P.; Kwon, J.G.; Cho, M.J.; Hong, J.P. Lymph Node to Vein Anastomosis (LNVA) for lower extremity lymphedema. J. Plast. Reconstr. Aesthetic Surg. JPRAS 2021, 74, 2059–2067. [Google Scholar] [CrossRef]
- Suzuki, Y.; Kajita, H.; Watanabe, S.; Otaki, M.; Okabe, K.; Sakuma, H.; Imanishi, N.; Kishi, K. Preoperative Photoacoustic versus Indocyanine Green Lymphography in Lymphaticovenular Anastomosis Outcomes for Lower Extremity Lymphedema: A Pilot Study. Microsurgery 2024, 44, e31153. [Google Scholar] [CrossRef] [PubMed]
- Lin, H.; Chen, F.; Lin, T.; Mo, J.; Chen, Z.; Wang, Z.; Liu, W. Beyond Magnification and Illumination: Ergonomics with a 3D Exoscope in Lumbar Spine Microsurgery to Reduce Musculoskeletal Injuries. Orthop. Surg. 2023, 15, 1556–1563. [Google Scholar] [CrossRef]
- Nishiyama, K. From Exoscope into the Next Generation. J. Korean Neurosurg. Soc. 2017, 60, 289–293. [Google Scholar] [CrossRef]
- Yoon, W.S.; Lho, H.W.; Chung, D.S. Evaluation of 3-Dimensional Exoscopes in Brain Tumor Surgery. J. Korean Neurosurg. Soc. 2021, 64, 289–296. [Google Scholar] [CrossRef]
- Vattipally, V.N.; Jiang, K.; Weber-Levine, C.; Rosin, R.; Davidar, A.D.; Hersh, A.M.; Khalifeh, J.; Ahmed, A.K.; Azad, T.D.; Ashayeri, K.; et al. Exoscope Use in Spine Surgery: A Systematic Review of Applications, Benefits, and Limitations. World Neurosurg. 2023, 184, 283–292.e3. [Google Scholar] [CrossRef]
- Iqbal, J.; Covell, M.M.; Jabeen, S.; Nadeem, A.; Gunjial, H.M.; Saboor, H.A.; Amin, A.; Salman, Y.; Hafeez, M.H.; Bowers, C.A. Comparative Analysis of Exoscope-Assisted Spine Surgery versus Operating Microscope: A Systematic Review. World Neurosurg. X 2023, 21, 100258. [Google Scholar] [CrossRef]
- Massarelli, O.; Vaira, L.A.; Gobbi, R.; Dell’aversana Orabona, G.; De Riu, G. Reconstruction of Full-Thickness Cheek Defect with Chimeric Facial Artery Free Flap: A Case Report. Microsurgery 2018, 38, 427–431. [Google Scholar] [CrossRef]
- McMaine, T.; Woo, B.; Julian, R. A Novel Use of the Exoscope for In-Vivo Microvascular Free Flaps. J. Oral Maxillofac. Surg. Off. J. Am. Assoc. Oral Maxillofac. Surg. 2023, 81, 511–514. [Google Scholar] [CrossRef]
- De Virgilio, A.; Costantino, A.; Russo, E.; Festa, B.M.; Pirola, F.; Spriano, G. Comparison Between the High-Definition 3D Exoscope and the Operating Microscope in Head and Neck Reconstruction. Int. J. Oral Maxillofac. Surg. 2024, 53, 475–481. [Google Scholar] [CrossRef]
- Samaha, Y.; Ray, E. Three-Dimensional Video Microscopy: Potential for Improved Ergonomics without Increased Operative Time? Arch. Plast. Surg. 2023, 50, 125–129. [Google Scholar] [CrossRef]
- De Virgilio, A.; Festa, B.M.; Costantino, A.; Mercante, G.; Spriano, G. High-Definition 3D Exoscope-Assisted Soft Palate Excision and Reconstruction. Head. Neck 2022, 44, 292–295. [Google Scholar] [CrossRef] [PubMed]
- Will, P.A.; Hirche, C.; Berner, J.E.; Kneser, U.; Gazyakan, E. Lymphovenous Anastomoses with Three-Dimensional Digital Hybrid Visualization: Improving Ergonomics for Supermicrosurgery in Lymphedema. Arch. Plast. Surgery. 2021, 48, 427–432. [Google Scholar] [CrossRef]
- Navalesi, P.; Oddo, C.M.; Chisci, G.; Frosolini, A.; Gennaro, P.; Abbate, V.; Prattichizzo, D.; Gabriele, G. The Use of Tactile Sensors in Oral and Maxillofacial Surgery: An Overview. Bioengineering 2023, 10, 765. [Google Scholar] [CrossRef]
- Müller, L.R.; Petersen, J.; Yamlahi, A.; Wise, P.; Adler, T.J.; Seitel, A.; Kowalewski, K.F.; Müller, B.; Kenngott, H.; Nickel, F.; et al. Robust Hand Tracking for Surgical Telestration. Int. J. Comput. Assist. Radiol. Surg. 2022, 17, 1477–1486. [Google Scholar] [CrossRef]
Variable | Metric | OM Group | Exoscope Group | Shapiro–Wilk Normality Test | Statistical Test Used | OM vs. Exoscope p-Value |
---|---|---|---|---|---|---|
Age at Surgery | Mean years (SD) | 55.5 (17.56) | 55.73 (15.07) | 0.066 | Student’s t-test | 0.973 |
Sex | Female | 78.57% (11/14) | 72.73% (8/11) | <0.001 | Chi-square | 1 |
Male | 21.43% (3/14) | 27.27% (3/11) | ||||
Etiology | Primary | 14.28% (2/14) | 9.1% (1/11) | <0.001 | Chi-square | 1 |
Secondary | 85.72% (12/14) | 90.9% (10/11) | ||||
Localization | Arm | 35.71% (5/14) | 45.45% (5/11) | <0.001 | Chi-square | 0.504 |
Leg | 64.29% (9/14) | 54.55% (6/11) | ||||
Surgical Time (min) | Mean minutes (SD) | 156.8 (48.82) | 133.2 (43.32) | 0.076 | Student’s t-test | 0.22 |
N of Incisions | Mean N (SD) | 2.0 (0.58) | 1.91 (0.54) | <0.001 | Mann–Whitney U | 0.717 |
N of Anastomoses | Mean N (SD) | 3.22 (2.05) | 2.73 (1.12) | <0.001 | Mann–Whitney U | 0.866 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Frosolini, A.; Benedetti, S.; Catarzi, L.; Massarelli, O.; Gennaro, P.; Gabriele, G. Exoscope and Supermicrosurgery: Pros and Cons of 3D Innovation in Lymphatic Surgery. J. Clin. Med. 2024, 13, 4974. https://doi.org/10.3390/jcm13174974
Frosolini A, Benedetti S, Catarzi L, Massarelli O, Gennaro P, Gabriele G. Exoscope and Supermicrosurgery: Pros and Cons of 3D Innovation in Lymphatic Surgery. Journal of Clinical Medicine. 2024; 13(17):4974. https://doi.org/10.3390/jcm13174974
Chicago/Turabian StyleFrosolini, Andrea, Simone Benedetti, Lisa Catarzi, Olindo Massarelli, Paolo Gennaro, and Guido Gabriele. 2024. "Exoscope and Supermicrosurgery: Pros and Cons of 3D Innovation in Lymphatic Surgery" Journal of Clinical Medicine 13, no. 17: 4974. https://doi.org/10.3390/jcm13174974