Exoscope in PNS Tumor Surgery

Surgery of peripheral nerve sheath tumors (PNST) aims to preserve functional fascicles by achieving gross-total resection. Increasing the visualization of anatomic details helps to identify the different layers and the tumor-nerve interface. The traditional microscope can present some limitations in this type of surgery, such as its physical obstruction. During the last years, the exoscope was developed as a new hybrid optical instrument between the operative microscope and the endoscope. Surgical EX grants a longer working distance, greater magnification, and a broader field of view compared to the traditional surgical microscope. This device seems to provide an excellent view of the anatomic details at the tumor-nerve interface, as visible in the 3D-4K monitor. The position and ergonomics of the first surgeon are widely described as comfortable with the exoscope, although if the co-surgeon is positioned in front of the first surgeon, his or her comfort is slightly impaired. The 4K monitor allowed a realistic, non-tiring 3D vision for the whole team, providing relevant information for didactic purposes. Whereas the reports about the use of this new device in PNST are still limited, it seems that after an adequate learning curve, exoscopes can represent feasible and comfortable instruments for PNST surgery.