Neurosurgical operating rooms are equipped with microscopes in order to provide a good standard of care. Nevertheless, in developing countries, microscopes are not always available. During a short period in a western Africa hospital, we adapted our smartphones as a valid alternative to the microscope.

Using a shaped tin can, a smartphone cover, and a rod fixed to the bed, we could make a support for a smartphone creating a simple “homemade” exoscope, which allowed us to have magnification and light in the surgical field.

Among others, we performed 5 surgical interventions of both spinal and brain surgery using our smartphone as a magnifier. This allowed us to overcome the absence of a better magnification system.

This simple “smartphone-based exoscope” allows surgeons to get an adequate magnification during surgery when microscopes or magnification goggles are not available. It can be a useful solution in developing countries where often nothing better is available 1).

The exoscope has been introduced as an alternative to microscopes or endoscopes. Barbagallo et al. used a 3D, HD exoscope (3D Vitom®, Karl Storz, Tuttlingen, Germany) in two patients undergoing two-level ACDF for cervical myelo-radiculopathy.

The exoscope was used during soft-tissue dissection, discectomy, osteophytectomy and cage insertion. Microsurgical drilling of posterior osteophytes, which usually requires adequate magnification and proper microscope angulation, was also performed with the exoscope.

Exoscope provided a 3D view of the surgical field similar to a microscope and allowed us to effectively and safely perform the above surgical steps. The main advantage of 3D exoscope-assisted surgery, compared to microscope-assisted surgery, is the possibility to generate videos with a similar view and image quality as perceived by the surgeon; therefore, the didactic capabilities of exoscopic videos are greater than those provided by microscopes. Exoscopes are also smaller compared to microscopes: this allows for comfortable use from early surgical steps to device implantation.

Barbagallo et al., think that exoscope-assisted surgery may become a safe and effective alternative to microscope-assisted surgery in ACDF 2).


Posterior Cervical Decompression and Fusion With Exoscope

Cenzato M, Fratianni A, Stefini R. Using a Smartphone as an Exoscope Where an Operating Microscope is not Available. World Neurosurg. 2019 Aug 30;132:114-117. doi: 10.1016/j.wneu.2019.08.137. [Epub ahead of print] PubMed PMID: 31476467.
Barbagallo GM, Certo F. 3D, HD exoscopic Anterior Cervical Discectomy and Fusion: a valid alternative to microscope-assisted surgery. World Neurosurg. 2019 Jun 14. pii: S1878-8750(19)31590-6. doi: 10.1016/j.wneu.2019.06.049. [Epub ahead of print] PubMed PMID: 31207374.
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