Surgical Technical Nuance of Exoscopic Cerebral Bypass Surgery Using the Mitaka 4K3D Exoscope

Abstract

Abstract Background and Objective Bypass surgery remains a crucial skill for neurosurgeons specializing in open or hybrid procedures. For years, these surgeries have been performed using an operating microscope. There have been limited publications on bypass surgeries using an exoscope. Here, we share our first-hand experience using the Mitaka HawkSight 4K3D HD exoscope in performing two bypass surgeries for moyamoya disease and intracranial atherosclerosis disease. The objective of the study is to show our experience and effectiveness of cerebral bypass with a Mitaka exoscope. Methods We observed two patients operated with an Mitaka exoscope in our center in 2024. Result The first case was a 35-year-old woman with moyamoya disease who presented with weakness for 1 month for which a combined bypass was done. The second case involved an 80-year-old male patient with cognitive impairment and right middle cerebral artery occlusion due to intracranial atherosclerosis disease, for which a direct bypass was done. In both instances, we utilized the exoscope with a 4K3D screen and 3D eyeglasses for enhanced visualization. Conclusion Bypass surgery can be conducted using an exoscope, which provides 4K3D HD images displayed on a 55-inch screen, offering an optimal view for the entire operating room, including both scrubbed and unscrubbed personnel. Unlike an operating microscope, everyone sees the same image as the surgeon, enhancing coordination and understanding among the team. Mastering the exoscope requires a learning curve that depends on experience, repetition, and unwavering dedication.