Real-time fluorescence-guided glioblastoma resection with 5-aminolevulinic acid using ORBEYE™

Background

Although fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) for glioblastomas (GBMs) can maximize the extent of resection (EOR), its superiority when used with ORBEYE™, a three-dimensional exoscope, compared with that of conventional microscopy remains unclear. This study aimed to evaluate the effectiveness of ORBEYE™ in 5-ALA FGS for GBM resection and compare the results with those of conventional microscopic FGS.

Methods

This retrospective, single-center study included 41 patients with histologically confirmed GBM who underwent 5-ALA FGS between January 2016 and April 2024. Twenty patients underwent surgery using a conventional operating microscope, while 21 underwent surgery using ORBEYE™. Tumor size, location, EOR, operative time, and surgical complications were compared between the two groups.

Results

No significant differences in EOR were observed between the groups; gross total resection was achieved in 45 % and 52.4 % of patients in the microscope and ORBEYE groups, respectively. Although not significant, the ORBEYE group had shorter operative times (195.3 ± 53.8 min) than the microscope group (219.4 ± 79.3 min). Postoperative complications were comparable between the two groups. ORBEYE™ allowed continuous resection under blue light without switching modes, enabling “real-time FGS with 5-ALA,” which enhanced surgical workflow, reduced surgeon’s fatigue, and eliminated the need for repositioning the surgeon’s eyes to the operating microscope eyepieces—although this was a subjective opinion of the surgeons.

Conclusions

ORBEYE™ provides effective real-time visualization during 5-ALA FGS for GBM resection, comparable to conventional microscopy. Its continuous fluorescence guidance and improved ergonomics may contribute to shorter operative times and reduced surgeon fatigue. ORBEYE™ is a promising tool in GBM surgery, warranting further in-depth investigation.