Comparison of surgical exoscope versus operating microscope in spine surgery: A Surgeon's perspective.

Introduction: A newly developed surgical visualization tool, the exoscope, has emerged as an alternative to the widely used operating microscope (OM). Through a qualitative survey, this study aimed to assess surgeons' perspectives on the exoscope compared to the OM, identifying its advantages, limitations, and barriers to widespread adoption. Research question: What are surgeons' perspectives of the exoscope compared to the OM? Materials and methods: A 29-question survey, designed by the authors, was used to compare the exoscope and the OM. The survey addressed key comparative aspects of both systems and included demographic information about participants and their institutions. Surgeons were recruited from internationally recognized organizations of expert spinal surgeons, with invitations sent via email. Responses were submitted anonymously, ensuring unbiased and authentic data collection. Results: Surgeons reported using the exoscope in a total of 1517 cases. Most surgeons found the exoscope comparable to or superior to the OM in many different parameters. 60.32 % of surgeons considered the exoscope to offer good learning opportunities, with most perceiving the learning curve as moderate (41.27 %) or mild (30.16 %). However, opinions on manoeuvrability and surgeon fatigue were divided-49.21 % found these aspects slightly better with the exoscope, a significant proportion felt they were worse. The primary drawback was its high cost, with additional concerns about ergonomics and resolution. Discussion and conclusion: From a surgeon's perspective, the exoscope presents several advantages over the OM. However, further improvements are needed, and it remains uncertain whether the exoscope can fully replace the OM in surgical practice.