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
