Exoscope and New Avenues in Spine Surgery

Abstract Advances in surgical visualization have transformed spine and neurosurgery, with the exoscope (EX) emerging as a promising alternative to the operating microscope. Offering high-definition 3D, 4K imaging with light-emitting diode–based illumination, the EX enhances precision while reducing heat generation and surgeon fatigue. Its ergonomic design, compact camera head, and extended working distance improve workflow, minimize interference with instruments, and promote surgeon comfort during prolonged procedures. Educational benefits are notable as the surgical team and trainees can share the same high-quality view. Integration of EX with its endoscope allows seamless toggling between exoscopic and endoscopic views, enhancing access to hidden structures. Additionally, near-infrared spectroscopy enables real-time tumor identification, improving the safety and completeness of resection. Despite challenges such as adaptation to screen-based coordination and cost, the EX represents a significant advancement in surgical visualization.