Exoscope-assisted spine surgery: Insights from orthopedic and neurosurgical teams through a survey

Introduction: Spine surgery requires precise visualization to ensure safety in anatomically complex regions. Traditional microscopes, though effective, have ergonomic and communication limitations. High-definition three-dimensional (3D) exoscopes address these challenges by providing superior image quality, depth perception, ergonomics, collaboration, and teaching opportunities, while supporting minimally invasive techniques. This study reports the experience of two Italian centers adopting the exoscope as a primary visualization tool, integrating surgeons' and staff perspectives through structured questionnaires. Methods: This retrospective, observational, dual-center study evaluated spinal procedures performed with the exoscope between January 2022 and June 2025 at two Italian institutions. Procedures included cervical, thoracic, and lumbar surgeries performed through anterior, posterior, and lateral approaches, and encompassed intradural and extradural pathologies. Clinical experience was complemented by two structured questionnaires, one for surgeons and one for non-surgeon team members, addressing image quality and visualization, ergonomics and fatigue, intraoperative communication and workflow, learning curve and implementation, and educational value. Results: A total of 880 spinal procedures were performed. Surgeons reported excellent visualization, illumination, magnification, depth perception, and ergonomics, with reduced fatigue and improved workflow. Competency was typically achieved within three cases. Non-surgeons confirmed improved image quality, intraoperative communication, awareness of surgical actions, and educational engagement. Both groups consistently endorsed the exoscope as a transformative surgical and teaching tool. Conclusions: The exoscope enhances visualization and ergonomics while fostering collaboration and education in the operating room. It offers significant advantages over traditional microscopes, improving precision, efficiency, and training across diverse spinal procedures, and represents a valuable tool for routine clinical practice.