VITOM®-3D in lumbar disc herniation: Preliminary experience

Objectives: In neurosurgery, optimal illumination and surgeon view's magnification are essential to perform delicate and dangerous operations, such as aneurysms clipping and tumors removal. In this paper, the authors report their initial experience using a 3D-exoscope in spinal surgical procedures. Patients and methods: From January to July 2018 we performed 9 lumbar discectomies using a VITOM (R)-3D exoscope. We decided to examine these cases, with particular attention to the surgical timing and to the postoperative results in terms of pain control (VAS). Patient positioning, surgical instruments and approach technique were essentially the same used routinely in standard spinal disc herniation surgery. A "control" group composed of 9 cases was selected from patients who underwent a standard discectomy during the same period with the same neurosurgeons in order to obtain two homogeneous and comparable populations. Results: The length of operative time was measured and appeared to be longer in exoscope-assisted discectomies than in the traditional procedures (average 160 min vs 133 min); moreover the one-month postoperative VAS of the two groups were collected and compared but, after a statistical analysis, these differences resulted to be not statistically significant. No technical difficulties or surgical complications were noted. Conclusions: Despite the limited group of patients, the VITOM (R)-3D exoscope can be considered an interesting instrument in spinal procedures. It cannot permanently substitute the operating microscope but it shows interesting characteristics that make it a useful tool for surgeon's comfort and a versatile and relatively economic instrument in the neurosurgical armamentarium, as a part of a 3D working station composed by endoscope and exoscope.