Evaluation of a Novel Three-Dimensional Robotic Digital Microscope (Aeos) in Neurosurgery

Simple Summary Current literature debates the development and implementation of three-dimensional Exoscopes in the daily routine of neurosurgical practice. This study evaluates the grade of satisfaction and intraoperative handling of the novel Aesculap Aeos Three-Dimensional Robotic Digital Microscope used in a Neurosurgical Department in the daily practice in a larger series of neurosurgical procedures. Our evaluation of this modern microscope technology focuses on three central aspects of microsurgical procedures. First, the visualization of tumor tissue and its discernment from healthy tissue, which is of utmost importance during neurooncological procedures. Furthermore, the aspect of ergonomics and fatigue during long, repetitive surgical procedures have been shown to cause work-related musculoskeletal disorders. Finally, the implementation of novel three-dimensional microscopes may be a promising tool for surgical education. Improved image quality, superior ergonomic comfort for the surgeon and increased accessibility within the surgical field have been noted as major advantages to date. Objective: Current literature debates the role of newly developed three-dimensional (3D) Exoscopes in the daily routine of neurosurgical practice. So far, only a small number of cadaver lab studies or case reports have examined the novel Aesculap Aeos Three-Dimensional Robotic Digital Microscope. This study aims to evaluate the grade of satisfaction and intraoperative handling of this novel system in neurosurgery. Methods: Nineteen neurosurgical procedures (12 cranial, 6 spinal and 1 peripheral nerve) performed over 9 weeks using the Aeos were analyzed. Ten neurosurgeons of varying levels of training were included after undergoing device instruction and training. Following every surgery, a questionnaire consisting of 43 items concerning intraoperative handling was completed. The questionnaires were analyzed using descriptive statistics. Results: No intraoperative complications occurred. Surgical satisfaction was ranked high (78.95%). In total, 84.21% evaluated surgical ergonomics as satisfactory, while 78.95% of the surgeons would like to use this system frequently. Image quality, independent working zoom function and depth of field were perceived as suboptimal by several neurosurgeons. Conclusion: The use of Aeos is feasible and safe in microsurgical procedures, and surgical satisfaction was ranked high among most neurosurgeons in our study. The system might offer advanced ergonomic conditions in comparison to conventional ocular-based microscopes.