Advancing spinal surgery: a systematic review of exoscope application in spinal procedures

Objective: This study aimed to assess the utility of the exoscope (EX) system in spine surgeries in comparison to the operating microscope (OM). Methods: The authors searched MEDLINE and Scopus until September 2023 to review common spinal surgeries with the EX-system, documenting procedures, surgery-related experiences, and outcomes. Results: We identified 35 articles that included 492 cases of EX-based spine surgeries. The most frequent procedures performed using the EX-system were discectomy, fusion, decompression, and tumor resection. Of the 35 articles, 25 (71%) reported using a 3D HD EX-system, with five employing a 4 K resolution monitor. Regarding video image quality, 19 articles (63%) found EX-system outcomes to be superior to OM, while six (17%) rated the quality on par with OM, and five articles (14%) deemed it inferior. Regarding surgical field visibility with the EX-system, 19 studies (70%) reported a superior experience, five studies (18%) found it similar to OM, and three reported it inferior. Regarding handling, 21 studies (87%) indicated easier management compared to OM. Twelve articles (52%) expressed a negative view on depth perception with the EX-system, seven (33%) rated it as superior, and two (14%) found it comparable to OM. Out of 29 articles discussing surgical ergonomics, 28 reported a satisfactory experience with the EX-system, and one found it comparable to OM. Conclusion: The EX-system provides adequate visualization and depth perception and is useful for training surgical assistants in spinal procedures. However, evidence of its superiority to traditional OM remains limited, necessitating further research to ascertain its clinical and surgical effectiveness.