2026 Poster Presentations
P354: ROBOTIC EXOSCOPE FACILITATES IMPROVED VISUALIZATION AND ERGONOMICS FOR TWO-SURGEON EYEBROW-BASED APPROACHES TO ORBITAL LESIONS
Sakibul Huq, MD; David Fernandes Cabral, MD; S. Tonya Stefko, MD; Paul A Gardner, MD; University of Pittsburgh Medical Center
Background: The robotic exoscope has recently emerged as an exciting alternative to conventional operating microscopes for intraoperative visualization during microsurgery. The exoscope uses a camera system controlled by a robotic arm that provides high definition, three-dimensional imaging with a panoramic view of the surgical field on a large monitor. Many authors have reported improved optics, ergonomics, and workflows with the exoscope compared to the microscope along with greater magnification, illumination, and depth of field perception. Despite these advantages, there are very few reports on use of the exoscope for surgical approaches to the orbit. Our center uses a team-based, two-surgeon approach to orbital lesions with collaboration between neurosurgery and oculoplastics and has applied the exoscope to facilitate this approach.
Methods: We review our initial experience using the exoscope for eyebrow incision-based approaches to the orbit for five patients with orbital lesions with excellent operative workflows and clinical outcomes.
Results: Five patients age 21-59 underwent eyebrow incision exoscope approaches to the orbit for cavernous lymphangioma, epidermoid cyst, fibrous dysplasia, nerve sheath tumor, and orbital arteriovenous malformation. Preoperative symptoms included retroorbital headaches, diplopia, ptosis, and a visible pulsatile mass and improved in all cases. All patients had gross total resection, preserved visual acuity and function, and excellent cosmetic outcome. There were no surgical complications. The exoscope offered excellent ergonomics for two surgeons operating simultaneously in parallel, including surgeons of different height. The exoscope was particularly well-suited in that it could illuminate the narrow space of the deep orbit and maintain focus on both superficial and deep structures simultaneously while allowing two surgeons to work from different or the same angle. It also allowed three-dimensional viewing for trainees who are often poorly exposed to orbital surgery.
Conclusions: The exoscope can be used successfully for a multitude of orbital pathologies. It provides some significant potential advantages for two-surgeon orbital surgery, including improved logistics working in a small deep, shared surgical field, improved illumination in the depth, and three-dimensional viewing for education.