Innovative visualization systems for head and neck surgery: "Orbeye" exoscope successfully applied

In February 2024, the "Orbeye" exoscope (Co. Olympus, Tokyo, Japan) was successfully applied in our ENT operating room for microsurgical procedures at the lateral skull base (reconstructive middle ear surgery for chronic otitis media with or without cholesteatoma, cochlear implant surgery and translabyrinthine removal of a vestibular schwannoma). The system is based on a 4K/3D camera, which can be swiveled in over the surgical field on a flexible semi-robotic arm (see Figures 1 and 2). The camera image is displayed on various monitors in 4K/3D image quality. The system used in the ENT surgery was kindly provided by the Department of Neurosurgery, where this device has been in clinical use for several years. 

Exoscopes from various medical device manufacturers have already been used in other surgical disciplines to complement conventional surgical microscopes. Their application in head and neck surgery is still limited due to the frequent need to operate through narrow and deep access routes.

In comparison to the surgical microscope, the use of an exoscope offers surgeons the advantage of an ergonomic, upright body position, which is facilitated by the compact design of the system. This results in less muscular fatigue. In addition, the image quality of the lens system of the surgical microscope differs from the image quality of the monitors in the operating room. However, when using an exoscope, the surgical team focuses together on one master monitor, which displays the surgical site in the highest image quality. This shared focus allows the intraoperative workflow and the quality of surgical training and further education to be improved. The ENT department at the Dresden University Hospital exhibits many years of expertise in performing test runs and complex evaluations of innovative visualization systems from various medical device manufacturers and has pooled this expertise in the junior research group "Surgical Assistance Systems in Head and Neck Surgery" since 2023. As a department of tertiary care, we are open to the technical innovations in the field of innovative and further development of exoscopes, which have been steadily driven forward by medical device manufacturers in recent years. The continuous improvement of the systems and the extension of indications towards head and neck surgery procedures can be expected to generate relevant impulses for the improvement of the quality of surgical care.