Novel 3D Head-Mounted Display For Microsurgery Combined With an Exoscope Device.

Importance: Three-dimensional (3D) monitor-assisted microsurgery, using images from an exoscope or digital microscope, offers ergonomic advantages for surgeons and facilitates educational collaboration. However, challenges remain with the placement of monitors and assistant positioning.

Objective: To evaluate the usability of a new head-mounted 3D display, the 3D View Vision, combined with the existing exoscope device, ORBEYE, for improved ergonomic positioning for surgeons and compatible visualization in microsurgical procedures.

Design, setting, and participants: A prospective observational study was conducted involving patients undergoing head and neck reconstruction requiring microvascular anastomosis at a single surgical center. The head-mounted 3D display was used in combination with the exoscope device during the procedures. This researcH was conducted from April 2023 to November 2023.

Intervention: The surgeon and assistant used the head-mounted 3D display for 3D visualization of the surgical field without the need for both 3D monitor and conventional optical microscope.

Main outcomes and measures: The primary outcome was successful completion of microvascular anastomosis with with comparable time, adequate visualization, and subjective ergonomic improvement. Secondary outcomes included intraoperative complications and teamwork efficiency.

Results: The patient mean (SD) age was 59.8 (9.1) years and all were male individuals. Microvascular anastomosis was successfully completed in all 5 patients. The use of the head-mounted 3D display allowed both the surgeon and assistant to position themselves ergonomically, facing each other directly, without concern of the positioning of monitors. End-to-end anastomosis for artery and end-to-side anastomosis for vein was conducted with a mean (SD) time of 23.0 (3.1) and 24.6 (6.9) minutes for each vessel type. Intraoperative reanastomosis was required in 1 patient due to arterial issues, but no other complications were reported.

Conclusions and relevance: This study found that the integration of the head-mounted 3D display with the exoscope device subjectively improved ergonomics for the surgeon and better visualization compared with using a 3D monitor and exoscope. By eliminating the need for monitor positioning, this technology also declutters the theater workspace.