2026 Poster Presentations
P336: COMPARATIVE PERFORMANCE OF MICROSCOPE AND EXOSCOPE IN SIMULATED SKULL BASE TASKS: EVALUATION OF DEXTERITY AND ACCURACY
Rodrigo Delpino Gehrke, MD1; Je Beom Hong, MD2; Kara A. Parikh, MD2; Moataz D. Abouammo, MD, MSC1; Francis Lorraine-Miller, MD1; Yongli Wang, MD1; Federico Valeri, MD2; Rebecca Leme Gallardo, MD1; Ricardo L. Carrau, MD, MBA, FACS1; Daniel M. Prevedello, MD2; 1Department of Otolaryngology/Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; 2Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
Introduction: Adequate surgical visualization is a key determinant of safety and precision in skull base surgery. Recently, exoscopes have been introduced as high-definition systems offering potential ergonomic advantages and are being explored as alternativesto conventional microscopes. However, their effectiveness in terms of manual performance and precision has not been fully validated. This study aimed to evaluate the performance of the exoscope compared with the surgical microscope through simulated microsurgical tasks.
Methods: A prospective experimental study was conducted with 16 participants (3 medical students, 8 residents, and 5 skull base surgeons). Each participant performed four microsurgical tasks—Tower of Hanoi puzzle, spiral tracing, square tracing, and microsurgical needle insertion into a synthetic model—under three visualization modalities: naked eye, surgical microscope (Leica ARveo8), and high-definition exoscope (Olympus Orbeye). All participants completed the tasks in a standardized laboratory setting. Primary outcomes were task completion time, error frequency, and accuracy, which were compared across modalities and proficiency levels.
Results: Sixteen participants (11 low- and 5 high-proficiency) completed all four tasks under three visualization modalities. In the disk-moving task, the low-proficiency group showed no significant differences between modalities, whereas the high-proficiency group performed faster with the microscope. Exoscope performance improved on repeat trials, suggesting a learning effect. In tracing tasks, completion times were similar across modalities, though low-proficiency participants showed greater variability. Critical errors increased with exoscope use, especially in square tracing, while spiral tracing was largely unaffected. Accuracy was reduced with the exoscope in square tracing for low-proficiency participants but remained comparable across modalities in the high-proficiency group. Notably, when using the exoscope, as task time increased, the number of critical errors decreased, indicating that slower movements may help diminish errors.
Conclusion: The exoscope demonstrated overall performance comparable to the surgical microscope in simulated skull base tasks. However, it was associated with a higher frequency of critical errors, particularly among less experienced participants. With repeated use, performance improved, and experienced surgeons maintained stable outcomes across modalities. Importantly, when using the exoscope, a negative correlation between task time and critical errors was observed, suggesting that slower, more deliberate movements can reduce error rates. This behavior appears to reflect a learning curve, where experienced surgeons adapt by deliberately reducing speed to compensate for the slight imaging delay, thereby enhancing safety and precision. These findings indicate that while the exoscope may present initial challenges in precision and error control, it remains a viable alternative to the microscope and holds promise for skull base surgical training and practice.