Embracing Exoscope in the Arsenal of Spine Surgeons in the Low-and Middle-Income Countries.

INTRODUCTION: Exoscope (EX) is a device that combines the convenience of an endoscope with the image clarity of an operating microscope (OM) to fill the void between the two. This study aims to compare the 2D EX with OM in spine surgeries and to explore its utility and feasibility in small and peripheral hospitals of low- and middle-income countries.

METHODS: 82 patients with intradural spinal tumors (extramedullary and intramedullary) aged more than 18 years were included between August 2021 to August 2023. Patients with other spinal pathologies were excluded. After each exoscopic surgery, the operating surgeon and assistant had to answer a questionnaire. Postoperatively, outcomes were measured as the length of hospital stay, CSF leak, and number of re-operations.

RESULT: Thirty-seven patients were included in the OM group and 45 patients were included in the EX group. In 62-67% of cases, the overall image quality of the EX was comparable to OM and in 29-38% of cases, it was superior to the OM. The preparation and installation of the EX were much easier and better than the OM in 93-100% of the cases. Maneuvering surgical instruments and workflow in the operating theatre was much more convenient in the EX group (95-100% of the cases). Ergonomics was far better in the EX group than in the OM group.

CONCLUSION: Spine surgeons can embrace the benefits of EX and increase their range of surgeries to be performed at the small operation theatre setup in low-middle income developing countries.