Exoscopes in Neurosurgery: A Bibliometric and Visualization Analysis

Abstract

Introduction

Exoscopes, introduced as an alternative to operative microscopes in neurosurgery, aim to enhance intraoperative visualization, ergonomics, cost-effectiveness, and patient outcomes. This study employs bibliometric analysis to delineate topic trends and fields within neurosurgery utilizing exoscopes.

Materials and Methods

Articles and reviews from January 1, 2002 to December 31, 2023, were manually retrieved from Scopus, based on predefined criteria encompassing publications related to exoscopes in neurosurgery. All publication records were imported and analyzed using Microsoft Excel and VOSviewer.

Results

A total of 186 articles were included for final analysis. While work on exoscopes was limited until 2015, there was an upsurge in publication output from 2018 to 2022. The United States led in the number of articles (72/186, 38.7%) and in total citations (1259). Brazil ranked first in average citation index (26.00). The Hospital of the University of Pennsylvania, United States, published the most articles (5), while Cedars-Sinai Medical Center USA accrued the highest number of citations (181). A.J. Schupper (4) and Constantinos Hadjipanayis (7) were the authors with the most publications as the first author and the last author, respectively. World Neurosurgery was the most prolific journal with 41 publications. Recent keywords centered around themes such as “ergonomics” (47 times) and “three-dimensional imaging” (44 times). Most collaboration occurred between developed countries such as the United States, Germany, Finland, and Austria. Most articles (87) focused on brain, with 25 articles focusing on spine.

Conclusion

Our findings offer valuable insights to identify potential research frontiers within different fields of neurosurgery in the coming years.

Keywords

bibliometrics - citation analysis - exoscopes - neurosurgery - operative microscopes

Introduction

The introduction of operative microscopes (OMs) marked a significant milestone in microsurgical procedures, serving as a cutting-edge visual enhancement tool. Over time, continuous advancements in optics, illumination, and integration into computer-assisted navigation have elevated OMs to the gold standard in microsurgery.[1] However, OMs have inherent limitations including restricted mobility, bulkiness, limited accessibility, and a confined operative view.[2] Moreover, ergonomic challenges associated with OMs contribute to intraoperative fatigue and the risk of work-related injuries.[3] [4]

In recent years, a paradigm shift has occurred with the introduction of exoscopes. An exoscope is an external telescope equipped with a highly advanced camera system, providing advanced magnification and digital image processing capabilities.[5] Exoscopes address critical challenges posed by OMs while offering additional benefits such as ease of use, improved ergonomics, magnified images of the surgical field, and augmented depth perception. Initially characterized by two-dimensional imaging, recent advancements have integrated three-dimensional (3D) visualization into exoscopes, offering surgeons a stereoscopic view of the surgical field.[6] Through the sophisticated combination of a high-resolution camera, light source, video display unit, and flexible arm, exoscopes offer neurosurgeons an optimal view of the surgical field, particularly crucial in intricate procedures involving small structures.[7] [8]

The emergence of exoscopes signifies a progression in microsurgical techniques, providing surgeons with a potent instrument capable of enhancing both surgical outcomes and patient safety. The versatility of exoscopes is evident in their application across various neurosurgical procedures, including skull base, transsphenoidal, cerebrovascular, and spinal surgeries, as well as otorhinolaryngological procedures.[9] [10] [11] [12] [13] [14] [15] Results obtained from these procedures have shown promising outcomes when compared with conventional visualization tools like OMs.

To date, no bibliometric study has focused on exoscopes in neurosurgery. This study aims to fill that gap by providing the first comprehensive bibliometric analysis of the topic. This bibliometric analysis aims to provide comprehensive insights into the current trends in publications related to exoscopes, considering both the quality and quantity of publications. Our goal is to explore the contributions of countries, institutions, journals, and authors to exoscope-related research and assist researchers in identifying current areas of interest, making predictions about the future trajectory of exoscope-related research.

Materials and Methods

Data Collection

Scopus, developed by Elsevier Co., is an abstract and indexing database with full-text links, offering comprehensive research capabilities. It is widely regarded as one of the largest and most comprehensive curated databases especially for bibliometric analysis, encompassing global research across various disciplines including medicine. Given its extensive coverage, we opted to retrieve data for this study through a computerized literature search using the Scopus database.[16]

Retrieval Strategies

The search for research articles related to exoscopes in neurosurgery was conducted on December 31, 2023. The following search terms were employed: “exoscope OR exoscopic AND neurosurgery OR brain OR spine OR cadaver OR laboratory.” Only articles published in English between January 1, 2002, and December 31, 2023, were included. The database search initially retrieved 236 publications, and after excluding editorials, reprints, book chapters, conference abstracts, proceedings papers, brief reports, retracted publications, corrections, news items, and non-English literary works, 186 publications were included in the final analysis. [Fig. 1] illustrates the flowchart of our retrieval strategy.

Fig. 1 Retrieval flowchart.

Data Extraction and Descriptive Analysis

Records of all publications, including titles, abstracts, countries of publication, publication years, authors, institutions, journals, keywords, citations, references, etc., were downloaded and exported in comma-separated value files. Data from these files were processed after importing them into Microsoft Excel (Version 16.77.1). Following data processing, the data was descriptively analyzed.

Bibliometric and Visualization Analysis

For bibliometric and visual analysis, VOSviewer (Version 1.6.19) was utilized. VOSviewer, developed by Professors Van Eck and Waltman, is a bibliometrics software with text mining capabilities for extracting crucial parameters from a large number of scientific articles. It generates maps and networks based on network, bibliographic, and text data.[17] Our research used VOSviewer to perform visual network analysis such as countries coauthorship analysis and keyword cooccurrence analysis.

Results

A total of 236 published articles were screened, resulting in the inclusion of 186 articles in the final analysis. Limited publications were observed until 2015, with a gradual increase thereafter, peaking in the years 2017 to 2022 ([Fig. 2]). [Fig. 2] illustrates a consistent growth trend in research papers on exoscopes in neurosurgery over the past 20 years. [Table 1] presents the top articles on exoscopes in neurosurgery research along with their citation counts.[4] [7] [10] [15] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33]

Fig. 2 Yearly publication trend.

Table 1 Top cited articles

Rank	Article	Year of publication	Citations
1	Initial Clinical Experience with a High-Definition Exoscope System for Microneurosurgery[18]	2010	101
2	A High-Definition Exoscope System for Neurosurgery and Other Microsurgical Disciplines: Preliminary Report[4]	2008	96
3	Vitom-3D for Exoscopic Neurosurgery: Initial Experience in Cranial and Spinal Procedures[19]	2017	86
4	VITOM 3D: Preliminary Experience in Cranial Surgery[20]	2017	72
5	The Exoscope in Neurosurgery: An Innovative “Point of View.” A Systematic Review of The Technical, Surgical, and Educational Aspects[21]	2019	71
6	Lessons Learned Using a High-Definition 3-Dimensional Exoscope for Spinal Surgery[22]	2019	69
7	Initial Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery[7]	2018	66
8	Advances In Intraoperative Optics: A Brief Review of Current Exoscope Platforms[23]	2020	59
9	The Exoscope in Neurosurgery: An Overview of The Current Literature of Intraoperative Use in Brain and Spine Surgery[10]	2021	53
10	Infratentorial Supracerebellar Resection of a Pineal Tumor Using a High Definition Video Exoscope (VITOM®)[24]	2012	52
11	Initial Experience with 3-Dimensional Exoscope-Assisted Transmastoid and Lateral Skull Base Surgery[15]	2019	52
12	Use Of the Video Telescope Operating Monitor (VITOM) as an Alternative to The Operating Microscope In Spine Surgery[25]	2012	51
13	Application of a Compact High-Definition Exoscope for Illumination and Magnification in High-Precision Surgical Procedures[26]	2017	51
14	First-In-Man Clinical Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery[27]	2019	46
15	Preliminary Clinical Microneurosurgical Experience with the 4K3-Dimensional Microvideoscope (ORBEYE) System for Microneurological Surgery: Observation Study[28]	2019	45
16	Pros And Cons of Using ORBEYE™ for Microneurosurgery[29]	2018	45
17	Endoneurosurgical Resection of Intraventricular and Intraparenchymal Lesions Using the Port Technique[30]	2013	44
18	From Exoscope into The Next Generation[31]	2017	44
19	3D Exoscope System in Neurosurgery-Comparison of a Standard Operating Microscope with a New 3D Exoscope in The Cadaver Laboratory[32]	2019	41
20	Fluorescence-Guided Surgery in High Grade Gliomas Using an Exoscope System[33]	2014	39

Contributions of Countries/Regions

The top 10 countries contributing significantly to publications in exoscope research are listed in [Table 2]. The United States led with the highest number of articles (72), followed by Italy (35), Germany (25), Japan (23), and China (11). In terms of total citations, the United States also held the top position (1,259), with an average citation index (ACI) reaching 17.49. Italy, Germany, Finland, and Brazil followed in citation frequency. The ranking by ACI placed Brazil at the top, followed by the United States, Germany, Malaysia, and Ireland ([Fig. 3]).

Table 2 Top countries

Rank	Country	Documents	Citations	ACI
1	United states	72	1,259	17.49
2	Italy	35	394	11.26
3	Germany	25	361	14.44
4	Japan	23	217	9.43
5	China	11	35	3.18
6	Finland	9	81	9.00
7	Austria	7	50	7.14
8	Russian	4	7	1.75
9	Dominican Republic	3	7	2.33
10	India	3	11	3.67
11	Ireland	3	25	11.67
12	Switzerland	3	16	5.33
13	Brazil	2	52	26.00

Abbreviation: ACI, average citation index.

Fig. 3 Publications from each country.

Contributions of Research Institutions

Top-cited institutions in exoscope research were predominantly located in the United States. Notable institutions, their publication volumes, and citations are detailed in [Table 3]. Cedars-Sinai Medical Center (United States) had the highest citations (181), followed by SBH Health System (United States), University of Pennsylvania (United States), Johns Hopkins (United States), and University of Helsinki (Finland). The ACI for institutions ranked Cedars-Sinai (60.33) at the top, followed by SBH Health System (39.00), Johns Hopkins (29.00), and Mayo Clinic Jacksonville Florida (16.00).

Table 3 Top institutions with highest number of citations

Rank	Organizations	Citations	Documents	ACI
1	Cedars-Sinai Medical Center, United States	181	3	60.33
2	SBH Health System, United States	78	2	39.00
4	Hospital of the University of Pennsylvania, United States	68	5	13.60
3	Johns Hopkins University School of Medicine, United States	58	2	29.00
5	University of Helsinki and Helsinki University Hospital, Finland	39	4	9.75
6	Mayo Clinic, Jacksonville, United States	32	2	16.00
7	RWTH Aachen University Hospital, Germany	11	4	2.75

Abbreviation: ACI, average citation index.

Contributions of Authors

In terms of first authors, A.J. Schupper (United States) led with four publications, followed by several authors with three articles each. Constantinos Hadjipanayis (United States) was the last author with the most publications (7), followed by Gabriel Zada and K.L. Chaichana (United States) with six each. David Langer (United States) and Martins Lehecka (Finland) were last authors in five articles each. Several authors had three publications as the last author. The details of top first and last authors are given in [Tables 4] and [5], respectively. An author-bibliographic coupling analysis map generated using VOSviewer is presented in [Fig. 4].

Table 4 Top first authors with highest number of articles

Rank	First author	Articles as first author	H-index of the author	Affiliations[a]
1	Schupper, Alexander J.	4	15	Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
2	de Divitiis, Oreste	3	43	Department of Neurosurgery, Università degli Studi di Napoli “Federico II,” Naples, Italy
3	Mamelak, Adam N.	3	51	Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, United States
4	Rossmann, Tobias	3	4	Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland, Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
5	Strickland, Ben A.	3	14	Department of Neurosurgery, University of Southern California, Los Angeles, CA, United States

^a Affiliations given here are at the time of article writing and may change afterwards.

Table 5 Top last authors with highest number of articles

Rank	Last author	Articles as last author	H-index of the author	Affiliations[a]
1	Hadjipanayis, Constantinos	7	44	Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States
2	Zada, Gabriel	6	42	Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
3	Chaichana, Kaisorn L.	6	51	Department of Neurosurgery, Mayo Clinic, Jacksonville, United States
4	Langer, David	5	27	Department of Neurosurgery, Lenox Hill Hospital, New York, NY, United States
5	Lehecka, Martin	5	27	Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland

^a Affiliations given here are at the time of article writing and may change afterwards.

Fig. 4 Authorship coupling analysis (co-citation analysis) using VOSviewer. Each node represents a different author, and the node size is proportionate to the number of citations.

Analysis of Core Journals

The top five journals publishing research on exoscopes in neurosurgery, along with their publication counts, impact factors, and average citation indices, are summarized in [Table 6]. World Neurosurgery had the highest number of publications (41), followed by Operative Neurosurgery (21), and Acta Neurochirurgica (13). Acta Neurochirurgica and Operative Neurosurgery had the highest impact factors (2.4 and 2.3, respectively). Operative Neurosurgery led in ACI (20.76).

Table 6 Top journals with most published articles

Rank	Journal	Number of publications count	Citation	JIF (2022)	JCR (2022)	ACI
1	World Neurosurgery	41	565	2.21	Q2	13.78
2	Operative Neurosurgery	21	439	2.3	Q2	20.76
3	Acta Neurochirurgica	13	150	2.4	Q1	11.54
4	Journal of Neurological Surgery, Part A: Central European Neurosurgery	7	106	0.98	Q3	15.14
5	Surgical Neurology International	5	16	0.76	Q3	3.20

Abbreviations: ACI, average citation index; JCR, Journal Citation Reports; JIF, Journal Impact Factor.

Keyword Analysis of Research Hotspots

Keyword cooccurrence analysis revealed the top 20 keywords in exoscope research ([Table 7]). The overlay visualization map ([Fig. 5]) highlighted early keywords focused on the use of exoscopes in neurosurgical procedures, while recent keywords emphasized ergonomics and diagnostic imaging. A word cloud of top author-indexed keywords is presented in [Fig. 6].

Fig. 5 Keywords cooccurrence analysis (overlay visualization map) using VOSviewer. Each node represents a different keyword, and the node size is proportionate to the number of times the keywords used in the articles.

Fig. 6 Word cloud of keywords.

Table 7 Top keywords

Rank	Keyword	Occurrences
1	human	167
2	article	138
3	humans	134
4	exoscope	122
5	neurosurgery	121
6	clinical article	94
7	adult	91
8	male	90
9	neurosurgical procedures	88
10	microsurgery	87
11	female	83
12	procedures	81
13	middle aged	59
14	aged	50
15	ergonomics	47
16	craniotomy	46
17	nuclear magnetic resonance imaging	46
18	brain tumor	44
19	three-dimensional imaging	44
20	diagnostic imaging	42

Analysis of Fields

Out of 186 articles, 164 were original articles and 22 were reviews. Articles covered various neurosurgical disciplines, with 87 focusing on the brain, 25 on the spine, and 26 on both. Fourteen articles explored topics related to otology. The detailed breakdown is provided in [Table 8].

Table 8 Articles in different fields

Fields	No. of articles
Brain only	87
Spine only	25
Brain and spine	26
Otology	14
Laboratory studies (cadaveric/anatomic specimens, animals)	13
Others (training models, devices, surveys, etc.)	23

Discussion

This study analyzes the evolution of research related to exoscopes, exploring the body of literature, contributions from countries, institutions, authors, journals, and prevailing research topics in exoscope utilization. Through a methodical approach, this study offers crucial perspectives to help researchers and clinicians navigate the growing literature and engage with the most recent developments in exoscope research. Scopus was selected as the database for this study, as it is considered as the most suitable bibliometric analysis database.[34] It offers researchers the ability to search both forward and backward from a particular citation. Compared with PubMed and Google Scholar, it provides highly structured metadata, including author affiliations, citation counts, and document types. Scopus integrates with tools like VOSviewer, enabling users to create visual maps of research collaborations, citation networks, and keyword cooccurrence.[35] [36]

Although exoscope as an intraoperative tool was discussed in the 1990s,[37] [38] its widespread use did not occur until after 2015. The rise in exoscope research is observed from 2017 onwards, with 2022 being the most productive year yielding 46 publications. The recent surge in exoscope research reflects the growing recognition of exoscope as a valuable surgical tool. This trend may be driven by technological improvements, such as the introduction of 3D exoscopes, emerging applications of exoscopes in microsurgery, and its other proposed benefits.[5] [39] [40] [41]

In terms of publication output, resource-rich countries dominate the landscape. The United States emerged as the most prolific contributor, publishing 72 articles. Italy, Germany, Japan, and China followed, indicating a notable concentration of research activity in these countries. The United States not only leads in publication quantity but also in total citations, amassing a significant 1,259 citations with an ACI of 17.49. Italy and Germany follow the United States in citation ranking, with 394 and 361 total citations, respectively, highlighting the impact of research originating from these nations. Ireland, Brazil, Germany, and Malaysia are also ranked high in the ACI, suggesting that even with somewhat smaller publication counts, their research related to exoscopes is frequently highly cited.[42] However, the underrepresentation of low- and middle-income countries (LMICs) in exoscope research highlights disparities in access to advanced surgical technologies. This emphasizes the importance of creating global research networks and ensuring equitable health care resources.

The top-cited institutions in exoscope research predominantly hail from the United States, with Cedars-Sinai Medical Center leading in both total citations (181) and ACI (60.33). Collaborations were observed among the United States, Brazil, Germany, and Switzerland.[42] Notably, although Egypt, Finland, and Austria may have fewer publications, they engage closely in collaboration with other major contributors. [Fig. 7] presents the coauthorship analysis showing collaboration between different countries with respect to research on exoscope. For future research, creating a worldwide research network and ensuring equitable health care resources for LMICs would be valuable undertakings.[42]

Fig. 7 Coauthorship analysis (unit of analysis = countries) using VOSviewer. Each node represents a different country, and the node size is proportionate to the contribution of each country in exoscope-related research.

The analysis of author contributions to exoscope research highlights A.J. Schupper from the United States as the leading contributor with four publications as the first author. Notably, Constantinos Hadjipanayis from the United States emerges as the one with the highest overall contribution as the last author, having authored seven publications. The first authorship acknowledges the individual who plays a pivotal role in the conception and execution of the research. The last author position suggests leadership roles in guiding and overseeing research projects.[43] Recognizing the contributions of both first and last authors is crucial for fostering a collaborative and equitable research environment, where seasoned researchers mentor and support junior colleagues.

World Neurosurgery (Impact Factor [IF] = 2.21, Q2), Operative Neurosurgery (IF = 2.3, Q2), and Acta Neurochirurgica (IF = 2.4, Q1) were the key journals in publishing a considerable volume of research and high-impact publications. The prevalence of words such as microsurgery, ergonomics, 3D imaging, brain tumors, and craniotomy in top 20 keywords suggest the exoscope applications, its advancements, and key areas of research being pursued for exoscope.[41] [44] Exoscope provides improved ergonomics for better operative experiences and longevity, especially in neurosurgery where musculoskeletal disorders are prevalent.[45] The 3D exoscope enhances surgeon comfort and satisfaction, particularly in procedures requiring nonneutral body positioning, like spine procedures[46] or supracerebellar infratentorial approach.[47] These continuous innovations are enhancing exoscope technology, leading to its increasingly widespread adoption.

The 186 articles included in this study reflect a diverse spectrum of topics within neurosurgery and otology. A significant number, 87 articles, focused on the brain, highlighting the predominance of research in this domain of neurosurgery. The spine is another important focus of interest, with 25 articles related to spinal neurosurgery. In addition, 26 articles covered both brain and spine, indicating the interrelation of these areas in neurosurgical research. Notably, otology, a discipline within ear and skull base surgery, was represented by 14 articles. The diverse applications of exoscope across neurosurgery, spinal surgery, and otology demonstrate its versatility and potential to revolutionize multiple fields.

This study finds its strength in being the first bibliometric review done for exoscopes. This study used not only performance analysis tools but also visualization tools to represent the literature on exoscope-related research. However, this study also had several limitations. The database used for this research was Scopus, which may have led to the omission of articles not published in Scopus. Despite its advantages, Scopus has certain inherent limitations that may affect the scope of this study. Compared with other databases such as Web of Science, Scopus offers relatively recent coverage, with indexing beginning primarily in 1970 for most disciplines and limited retrospective inclusion of older publications. As a result, we might have inadvertently missed some earlier articles. Similarly, Scopus covers a broad range of document types including articles, reviews, and conference papers, it excludes some formats like books, book chapters, and theses, which are often included in Google Scholar or PubMed. Language and time filters were used, which might have excluded some relevant articles. The quality of studies was not considered in this review.[42]

Conclusion

Exoscope has been found to be a valuable tool in neurosurgical armamentarium with the surge in research related to exoscope starting in 2017. The United States is the most important contributor, followed by Italy and Germany. World Neurosurgery is the journal that has published the most articles related to exoscope. Recent keywords such as 3D technology and ergonomics suggest the recent advancements and hotspots in exoscopic research. Exoscopes have been used in diverse surgical procedures from brain and spine to otorhinolaryngological procedures indicating its versatile utilization. Future advancements and research will be vital as exoscope can be a new gold standard in microneurosurgery.

Conflict of Interest

None declared.

Authors' Contributions

K.U.R. and M.F. contributed to the conception and design of the study. K.U.R., S.S., and R.A.G. conducted the literature search and data extraction. The results and interpretation were carried out by S.S., R.A.G., and A.M.K. Manuscript preparation was undertaken by K.U.R., S.S., R.A.G., and A.M.K., while M.F. provided a critical review. The revision and final approval of the manuscript were completed by M.F.

• References

• 1 Uluç K, Kujoth GC, Başkaya MK. Operating microscopes: past, present, and future. Neurosurg Focus 2009; 27 (03) E4
• 2 Siller S, Zoellner C, Fuetsch M, Trabold R, Tonn JC, Zausinger S. A high-definition 3D exoscope as an alternative to the operating microscope in spinal microsurgery. J Neurosurg Spine 2020; 33 (05) 705-714
• 3 Fisher SM, Teven CM, Song DH. Ergonomics in the operating room: the cervicospinal health of today's surgeons. Plast Reconstr Surg 2018; 142 (05) 1380-1387
• 4 Mamelak AN, Danielpour M, Black KL, Hagike M, Berci G. A high-definition exoscope system for neurosurgery and other microsurgical disciplines: preliminary report. Surg Innov 2008; 15 (01) 38-46
• 5 Pafitanis G, Hadjiandreou M, Alamri A, Uff C, Walsh D, Myers S. The exoscope versus operating microscope in microvascular surgery: a simulation non-inferiority trial. Arch Plast Surg 2020; 47 (03) 242-249
• 6 Fiani B, Jarrah R, Griepp DW, Adukuzhiyil J. The role of 3D exoscope systems in neurosurgery: an optical innovation. Cureus 2021; 13 (06) e15878
• 7 Sack J, Steinberg JA, Rennert RC. et al. Initial experience using a high-definition 3-dimensional exoscope system for microneurosurgery. Oper Neurosurg (Hagerstown) 2018; 14 (04) 395-401
• 8 Boaro A, Moscolo F, Feletti A. et al. Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon. Brain Spine 2022; 2: 100926
• 9 Jarmula J, de Andrade EJ, Kshettry VR, Recinos PF. The current state of visualization techniques in endoscopic skull base surgery. Brain Sci 2022; 12 (10) 1337
• 10 Montemurro N, Scerrati A, Ricciardi L, Trevisi G. The exoscope in neurosurgery: an overview of the current literature of intraoperative use in brain and spine surgery. J Clin Med 2021; 11 (01) 223
• 11 Ferlito S, La Mantia I, Caruso S. et al. High definition three-dimensional exoscope (VITOM 3D) in E.N.T. surgery: a systematic review of current experience. J Clin Med 2022; 11 (13) 3639
• 12 Garneau JC, Laitman BM, Cosetti MK, Hadjipanayis C, Wanna G. The use of the exoscope in lateral skull base surgery: advantages and limitations. Otol Neurotol 2019; 40 (02) 236-240
• 13 Patel NV, Ligas B, Gandhi S. et al. Internal maxillary to middle cerebral artery bypass using an anterior tibial artery graft, performed using a 3-dimensional exoscope: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 2020; 19 (02) E187
• 14 Nawabi NLA, Saway BF, Cunningham C. et al. Intraoperative performance with the exoscope in spine surgery: an institutional experience. World Neurosurg 2024; 182: 208-213
• 15 Smith S, Kozin ED, Kanumuri VV. et al. Initial experience with 3-dimensional exoscope-assisted transmastoid and lateral skull base surgery. Otolaryngol Head Neck Surg 2019; 160 (02) 364-367
• 16 Burnham JF. Scopus database: a review. Biomed Digit Libr 2006; 3 (01) 1
• 17 van Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics 2010; 84 (02) 523-538
• 18 Mamelak AN, Nobuto T, Berci G. Initial clinical experience with a high-definition exoscope system for microneurosurgery. Neurosurgery 2010; 67 (02) 476-483
• 19 Oertel JM, Burkhardt BW. Vitom-3D for exoscopic neurosurgery: initial experience in cranial and spinal procedures. World Neurosurg 2017; 105: 153-162
• 20 Rossini Z, Cardia A, Milani D, Lasio GB, Fornari M, D'Angelo V. VITOM 3D: preliminary experience in cranial surgery. World Neurosurg 2017; 107: 663-668
• 21 Ricciardi L, Chaichana KL, Cardia A. et al. The exoscope in neurosurgery: an innovative “point of view”. A systematic review of the technical, surgical, and educational aspects. World Neurosurg 2019; 124: 136-144
• 22 Kwan K, Schneider JR, Du V. et al. Lessons learned using a high-definition 3-dimensional exoscope for spinal surgery. Oper Neurosurg (Hagerstown) 2019; 16 (05) 619-625
• 23 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 (01) 84-93
• 24 Mamelak AN, Drazin D, Shirzadi A, Black KL, Berci G. Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM®). J Clin Neurosci 2012; 19 (02) 306-309
• 25 Shirzadi A, Mukherjee D, Drazin DG. et al. Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine 2012; 37 (24) E1517-E1523
• 26 Krishnan KG, Schöller K, Uhl E. Application of a compact high-definition exoscope for illumination and magnification in high-precision surgical procedures. World Neurosurg 2017; 97: 652-660
• 27 Khalessi AA, Rahme R, Rennert RC. et al. First-in-man clinical experience using a high-definition 3-dimensional exoscope system for microneurosurgery. Oper Neurosurg (Hagerstown) 2019; 16 (06) 717-725
• 28 Murai Y, Sato S, Yui K. et al. Preliminary clinical microneurosurgical experience with the 4K3-dimensional microvideoscope (ORBEYE) system for microneurological surgery: observation study. Oper Neurosurg (Hagerstown) 2019; 16 (06) 707-716
• 29 Takahashi S, Toda M, Nishimoto M. et al. Pros and cons of using ORBEYE™ for microneurosurgery. Clin Neurol Neurosurg 2018; 174: 57-62
• 30 McLaughlin N, Prevedello DM, Engh J, Kelly DF, Kassam AB. Endoneurosurgical resection of intraventricular and intraparenchymal lesions using the port technique. World Neurosurg 2013; 79 (2, Suppl): 18.e1-18.e8
• 31 Nishiyama K. From exoscope into the next generation. J Korean Neurosurg Soc 2017; 60 (03) 289-293
• 32 Herlan S, Marquardt JS, Hirt B, Tatagiba M, Ebner FH. 3D exoscope system in neurosurgery-comparison of a standard operating microscope with a new 3D exoscope in the cadaver lab. Oper Neurosurg (Hagerstown) 2019; 17 (05) 518-524
• 33 Belloch JP, Rovira V, Llácer JL, Riesgo PA, Cremades A. Fluorescence-guided surgery in high grade gliomas using an exoscope system. Acta Neurochir (Wien) 2014; 156 (04) 653-660
• 34 Baas J, Schotten M, Plume A, Côté G, Karimi R. Scopus as a curated, high-quality bibliometric data source for academic research in quantitative science studies. Quant Sci Stud 2020; 1 (01) 377-386
• 35 Singh VK, Singh P, Karmakar M, Leta J, Mayr P. The journal coverage of Web of Science, Scopus and Dimensions: a comparative analysis. Scientometrics 2021; 126 (06) 5113-5142
• 36 Elsevier: Scopus content coverage guide - Google Scholar. Accessed February 5, 2025 at: https://scholar.google.com/scholar_lookup?title=Elsevier%20Content%20Coverage%20Guide&publication_year=2010&
• 37 Gildenberg PL, Ledoux R, Cosman E, Labuz J. The exoscope–a frame-based video/graphics system for intraoperative guidance of surgical resection. Stereotact Funct Neurosurg 1994; 63 (1-4): 23-25
• 38 Gildenberg PL, Labuz J. Stereotactic craniotomy with the exoscope. Stereotact Funct Neurosurg 1997; 68 (1-4 Pt 1): 64-71
• 39 Veldeman M, Rossmann T, Huhtakangas J. et al. Three-dimensional exoscopic versus microscopic resection of vestibular schwannomas: a comparative series. Oper Neurosurg (Hagerstown) 2023; 24 (05) 507-513
• 40 Reddy R, Chu K, Deebel NA. et al. A comparative analysis of ergonomic risk utilizing the 4K-3D exoscope versus standard operating microscope for male fertility microsurgery. Urology 2023; 172: 115-120
• 41 Schupper AJ, Hrabarchuk EI, McCarthy L, Hadjipanayis CG. Improving surgeon well-being: ergonomics in neurosurgery. World Neurosurg 2023; 175: e1220-e1225
• 42 Faure MC, Munung NS, Ntusi NAB, Pratt B, de Vries J. Considering equity in global health collaborations: a qualitative study on experiences of equity. PLoS One 2021; 16 (10) e0258286
• 43 Go B, Suresh N, Go C. et al. Gender analysis of the top classic papers in otolaryngology head and neck surgery. World J Otorhinolaryngol Head Neck Surg 2022; 9 (02) 160-167
• 44 Haeren R, Hafez A, Lehecka M. Visualization and maneuverability features of a robotic arm three-dimensional exoscope and operating microscope for clipping an unruptured intracranial aneurysm: video comparison and technical evaluation. Oper Neurosurg (Hagerstown) 2022; 22 (01) 28-34
• 45 Schupper AJ, Eskandari R, Kosnik-Infinger L. et al. A multicenter study investigating the surgeon experience with a robotic-assisted exoscope as part of the neurosurgical armamentarium. World Neurosurg 2023; 173: e571-e577
• 46 Lavé A, Gondar R, Demetriades AK, Meling TR. Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review. Acta Neurochir (Wien) 2020; 162 (09) 2213-2220
• 47 Roa JA, Schupper AJ, Yaeger K, Hadjipanayis CG. Use of the 3D exoscope for the supracerebellar infratentorial approach in the concorde position: an effective and ergonomic alternative. Illustrative cases. J Neurosurg Case Lessons 2022; 3 (19) CASE21626

Publication History

Article published online:
31 March 2025