Total Operative Time ( in Min ) for Spinal Surgical Procedures When Using Either the VITOM System or the Traditional OM Surgery Patients

Study Design. Prospective cohort study. Objective. To evaluate the effi cacy of video telescope operating monitor (VITOM) as an alternative to operative microscope (OM) in spinal surgery. Summary of Background Data. The surgical operating microscope can be expensive, cumbersome, and ergonomically disadvantageous. VITOM is a novel telescope-based exoscope system that can be used as an alternative or supplement to OM. Methods. Patients undergoing spinal surgery were enrolled in a prospective cohort study between December 2008 and March 2011. Age, sex, and operation-matched patients undergoing surgery using the standard OM served as the control group. During surgery, the VITOM system was used in place of the OM in 24 patients. Operative time, length of postoperative hospital stay, and intraoperative complications were assessed. Results. A total of 48 patients were studied in 2 equal cohorts of 24 patients each. Within each cohort, patients underwent singlelevel (n = 4) and 2-level (n = 7) posterior decompression as well as single-level (n = 11) and 2-level (n = 2) transforaminal lumbar interbody fusions via VITOM, with an equal number of controls using OM. There were no signifi cant differences in age ( P = 0.79) or sex ( P = 0.77) between cohorts. There were no statistically signifi cant differences in mean operative room time for single-level decompressions ( P = 0.38), 2-level decompressions ( P = 0.12), single-level transforaminal lumbar interbody fusions ( P = 0.13), or 2-level transforaminal lumbar interbody fusions ( P = 0.15). Postoperative hospital length The application of the binocular operating microscope (OM) in microsurgery was fi rst described in 1962, when Jacobson et al 1 published a report of its use in a middle cerebral artery endarterectomy. In 1977, Caspar2 and Yaşargil 3 implemented the OM in spine surgery by performing an open microdiscectomy. The OM has since become the mainstay of modern microsurgery due to a signifi cant magnifi cation and illumination advantage when visualizing delicate vascular structures, tumor borders, and spinal anatomy. With a focal length between 200 and 400 mm, the OM provides space for standard microsurgical instruments to be placed in the operative fi eld without obstructing or displacing the microscope. OM also provides a wide range of smooth magnifi cation using an electronic drive system, 3-dimensional perception using binocular viewing lenses, and a hydraulic counterbalance system allowing for visualization in nearly any direction. Despite these advantages, the OM has drawbacks. Because of the heavy frame of the head stage, it requires a large, cumbersome counterbalance system for stabilization that inhibits maneuverability, occupies a large space in the operating room, and limits movement of surgical personnel. OMs are also expensive, ranging between US $250,000 and $400,000 each. Service contracts, maintenance personnel, and need for replacement parts add further costs. In addition, operative fatigue can be signifi cant because visualization via the OM often requires the surgeon and the assistant to be working From the * Cedars-Sinai Medical Center, Los Angeles, CA; and † Drexel University College of Medicine, Philadelphia, PA . Acknowledgment date: April 25, 2012. Revision date: August 8, 2012. Acceptance date: August 12, 2012. The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication. Karl Storz Endoscopy grant funds were received to support this work. One or more of the author(s) has/have received or will receive benefi ts for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position. Address correspondence and reprint requests to Khawar Siddique, MD, Cedars-Sinai Medical Center, 444 South San Vicente Blvd., Ste. 800, Los Angeles, CA 90048; E-mail: siddiquek@cshs.org of stay averaged 2.9 days for the VITOM group versus 2.8 days for the traditional OM group ( P = 0.75). There were no intraoperative complications in either group. Subjectively, surgeons rated the image quality as very high and equal to the OM. Conclusion. The VITOM system for spinal surgery provides outstanding image quality and an ease of manipulation rivaling the OM. There were no statistically signifi cant differences in mean operative room time, intraoperative complications, or total hospital length of stay when using this novel system in several common spinal procedures relative to the OM.