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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(03): 634-637
DOI: 10.4103/ajns.AJNS_148_21
Case Report

Four hands surgery for intracerebral hemorrhage using orbeye: Educational values and ergonomic advantages – A technical note

Tomoaki Murakami
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
,
Shingo Toyota
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
,
Takuya Suematsu
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
,
Yuki Wada
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
,
Kanji Nakagawa
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
,
Takeshi Shimizu
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
,
Kanji Mori
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
,
Takuyu Taki
Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo
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We have developed a new educational approach to microsurgery in which a trainee and supervisor can cooperate with “4 hands” using the exoscope. We evaluated 4-hands surgery for intracranial hemorrhage (ICH) using the exoscope to validate the educational value and ergonomic advantages of this method. Thirty consecutive patients who underwent surgery for ICH using the exoscope between December 2018 and May 2020 were studied retrospectively. All operations were performed by a team comprising a supervisor (assistant) and a trainee (main operator). The assistant set the visual axis of the exoscope, and adjusted focus and magnification as a scopist. After setting the ORBEYE, the supervisor helped retract the brain and withdraw and irrigate the hematoma using suction tubes or brain retractors. Moreover, the trainee evacuated the hematoma with a suction tube and coagulated using bipolar forceps. Patient background and results of treatment were evaluated. Intraoperative postures of the operators were observed, and schemas compared with the use of a conventional microscope were developed. All microsurgical procedures were accomplished by a trainee with a supervisor using only the exoscope. During the surgery, the surgeons could work in a comfortable posture, and the supervisor and trainee could cooperate in microsurgical procedures using their four hands. The results of the present case series concerning evacuation of ICH were not inferior to those described in previous reports. To increase opportunities for education in microsurgery, 4-hands surgery for ICH using the exoscope appears feasible and safe and offered excellent educational value and ergonomic advantages.

Key-words:

Craniotomy - evacuation - exoscope - intracranial hemorrhage - ORBEYE

Financial support and sponsorship

Nil.




Publication History

Received: 11 April 2021

Accepted: 30 May 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ikawa F, Hidaka T, Kurokawa Y, Yonezawa U, Kobayashi S. Present Situation of Therapy for Cerebral Aneurysm in Japan: According to the Data of our Institute, the Japan Standard Stroke Registry Study, and the Japan Neurosurgical Society. Surg Cereb Stroke 2015;43:262-6.
  • 2 Qureshi AI, Vazquez G, Tariq N, Suri MF, Lakshminarayan K, Lanzino G. Impact of International Subarachnoid Aneurysm Trial results on treatment of ruptured intracranial aneurysms in the United States. Clinical article. J Neurosurg 2011;114:834-41.
  • 3 Lai L, Morgan MK. The impact of changing intracranial aneurysm practice on the education of cerebrovascular neurosurgeons. J Clin Neurosci 2012;19:81-4.
  • 4 Inoue T. As a young neurosurgeon in training: The importance of thorough microsurgical training and professionalism. JPN J Neurosurg 2012;21:4-8.
  • 5 Izumo T, Ujifuku K, Baba S, Morofuji Y, Horie N, Matsuo T. Initial experience of ORBEYE™ surgical microscope for carotid endarterectomy. Asian J Neurosurg 2019;14:839-42.
  • 6 Langer DJ, White TG, Schulder M, Boockvar JA, Labib M, Lawton MT. Advances in intraoperative optics: A brief review of current exoscope platforms. Oper Neurosurg (Hagerstown) 2020;19:84-93.
  • 7 Murai Y, Sato S, Yui K, Morimoto D, Ozeki T, Yamaguchi M, et al. Preliminary clinical microneurosurgical experience with the 4K3-dimensional microvideoscope (ORBEYE) system for microneurological surgery: Observation study. Oper Neurosurg (Hagerstown) 2019;16:707-16.
  • 8 Nossek E, Schneider JR, Kwan K, Kulason KO, Du V, Chakraborty S, et al. Technical aspects and operative nuances using a high-definition 3-dimensional exoscope for cerebral bypass surgery. Oper Neurosurg (Hagerstown) 2019;17:157-63.
  • 9 Shimizu T, Toyota S, Nakagawa K, Murakami T, Mori K, Kishima H, et al. Retrosigmoid approach in the supine position using ORBEYE: A consecutive series of 14 cases. Neurol Med Chir (Tokyo) 2021;61:55-61.
  • 10 Iwata T, Toyota S, Kudo A, Nakagawa K, Shimizu T, Murakami T, et al. Microsurgery “Under the Eaves” using ORBEYE: A case of dural arteriovenous fistula of the anterior cranial fossa. World Neurosurg 2020;138:178-81.
  • 11 Ahmad FI, Mericli AF, DeFazio MV, Chang EI, Hanasono MM, Pederson WC, et al. Application of the ORBEYE three-dimensional exoscope for microsurgical procedures. Microsurgery 2020;40:468-72.
  • 12 Bakhsheshian J, Strickland BA, Jackson C, Chaichana KL, Young R, Pradilla G, et al. Multicenter investigation of channel-based subcortical trans-sulcal exoscopic resection of metastatic brain tumors: A retrospective case series. Oper Neurosurg (Hagerstown) 2019;16:159-66.
  • 13 Beez T, Munoz-Bendix C, Beseoglu K, Steiger HJ, Ahmadi SA. First clinical applications of a high-definition three-dimensional exoscope in pediatric neurosurgery. Cureus 2018;10:e2108.
  • 14 Oertel JM, Burkhardt BW. Vitom-3D for exoscopic neurosurgery: Initial experience in cranial and spinal procedures. World Neurosurg 2017;105:153-62.
  • 15 Muhammad S, Lehecka M, Niemelä M. Preliminary experience with a digital robotic exoscope in cranial and spinal surgery: A review of the Synaptive Modus V system. Acta Neurochir (Wien) 2019;161:2175-80.
  • 16 Nishiyama K. From exoscope into the next generation. J Korean Neurosurg Soc 2017;60:289-93.
  • 17 Xu X, Chen X, Li F, Zheng X, Wang Q, Sun G, et al. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: A comparison with craniotomy. J Neurosurg 2018;128:553-9.
  • 18 Shi J, Cai Z, Han W, Dong B, Mao Y, Cao J, et al. Stereotactic catheter drainage versus conventional craniotomy for severe spontaneous intracerebral hemorrhage in the basal ganglia. Cell Transplant 2019;28:1025-32.
  • 19 Brouwers HB, Raffeld MR, van Nieuwenhuizen KM, Falcone GJ, Ayres AM, McNamara KA, et al. CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery. Neurology 2014;83:883-9.
  • 20 Zhou H, Zhang Y, Liu L, Han X, Tao Y, Tang Y, et al. A prospective controlled study: Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol 2011;11:76.
  • 21 Kellner CP, Song R, Pan J, Nistal DA, Scaggiante J, Chartrain AG, et al. Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation. J Neurointerv Surg 2020;12:489-94.
  • 22 Nakanishi R, Fukunaga Y, Mukai T, Nagasaki T, Yamaguchi T, Akiyoshi T, et al. Educational system for acquiring appropriate laparoscopic colorectal surgical skills: Analysis in a Japanese high-volume cancer center. Surg Endosc 2021;35:2660-6.