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.