{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:28:34Z","timestamp":1789576114775,"version":"build-2803163510"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Ulm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Exoscopic surgery is an emerging visualization technique in head and neck surgery, offering a promising alternative to conventional surgical microscopes. AI-assisted functions and high-quality imaging support its integration into modern surgical workflows. Eleven head and neck procedures were evaluated, including otologic surgery, parotidectomy and microvascular anastomosis using exoscopic techniques. Subjective feedback was obtained from four primary surgeons and four surgical assistants (response rate 100%) via a custom, non-validated questionnaire comprising 18 items. Six questions compared exoscope versus standard magnification (microscope or surgical loupes) across domains including anatomical structure identification, depth perception, field illumination and magnification, preoperative setup handling, and overall preference. Twelve questions addressed ergonomic comfort, 3D glasses and head-mounted display (HMDmd) wearability, and intraoperative handling. Ergonomic strain was assessed using the validated Rapid Upper Limb Assessment (RULA). Exoscopic systems demonstrated advantages, such as superior 4K-3D imaging, enhanced depth perception, improved ergonomics and facilitated intraoperative collaboration and education. RULA scores indicated reduced musculoskeletal strain, especially during longer procedures. Mean setup time was 4:14 min (range: 4:05\u20134:45 min), including draping (mean 2:04 min; range: 1:50\u20132:30 min). Surgeons described a brief adaptation period, primarily related to foot pedal control and digital interface navigation. AI-assisted features, including Auto-Center and Voice Control, further optimized workflow. Exoscopic surgery offers benefits for head and neck procedures requiring sustained magnification and precision. Short training times and ongoing technological advancements, such as improved working distances, head-mounted displays, and cost efficiency, are expected to further enhance its clinical value.<\/jats:p>","DOI":"10.1007\/s11701-025-02551-7","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T18:00:46Z","timestamp":1752516046000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Exoscopic-assisted head and neck surgery: a comparative evaluation optimizing ergonomics and workflow"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7311-0775","authenticated-orcid":false,"given":"J. P.","family":"Lingl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. K.","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Goldberg-Bockhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Greve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Boehm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"2551_CR1","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1007\/s11701-021-01294-5","volume":"16","author":"F Boehm","year":"2022","unstructured":"Boehm F, Schuler PJ, Riepl R, Schild L, Hoffmann TK, Greve J (2022) Performance of microvascular anastomosis with a new robotic visualization system: proof of concept. J Robot Surg 16:705\u2013713. https:\/\/doi.org\/10.1007\/s11701-021-01294-5","journal-title":"J Robot Surg"},{"key":"2551_CR2","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.1007\/s00405-022-07785-x","volume":"280","author":"E Chebib","year":"2023","unstructured":"Chebib E, Benoit C, Bois E, Teissier N, Van Den Abbeele T (2023) New surgical frontiers for 4K 3D-exoscope in paediatric head and neck surgery. Eur Arch Otorhinolaryngol 280:2033\u20132041. https:\/\/doi.org\/10.1007\/s00405-022-07785-x","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2551_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/ono.0000000000000024","volume":"2","author":"H Chiang","year":"2022","unstructured":"Chiang H, Ledbetter L, Kaylie DM (2022) Systematic review of otologic and neurotologic surgery using the 3-dimensional exoscope. Otol Neurotol Open 2:1\u201324. https:\/\/doi.org\/10.1097\/ono.0000000000000024","journal-title":"Otol Neurotol Open"},{"key":"2551_CR4","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1002\/hed.26623","volume":"43","author":"A De Virgilio","year":"2021","unstructured":"De Virgilio A, Costantino A, Ferreli F, Malvezzi L, Zocchi J, Pellini R, Mercante G, Spriano G (2021) High-definition three-dimensional exoscope for head and neck reconstruction: prospective analysis of 27 consecutive patients. Head Neck 43:1574\u20131580. https:\/\/doi.org\/10.1002\/hed.26623","journal-title":"Head Neck"},{"key":"2551_CR5","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.ijom.2023.11.004","volume":"53","author":"A De Virgilio","year":"2024","unstructured":"De Virgilio A, Costantino A, Russo E, Festa BM, Pirola F, Spriano G (2024) Comparison between the high-definition 3D exoscope and the operating microscope in head and neck reconstruction. Int J Oral Maxillofac Surg 53:475\u2013481. https:\/\/doi.org\/10.1016\/j.ijom.2023.11.004","journal-title":"Int J Oral Maxillofac Surg"},{"key":"2551_CR6","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1016\/j.ijom.2020.01.022","volume":"49","author":"A De Virgilio","year":"2020","unstructured":"De Virgilio A, Iocca O, Di Maio P, Mercante G, Mondello T, Yiu P, Malvezzi L, Pellini R, Ferreli F, Spriano G (2020) Free flap microvascular anastomosis in head and neck reconstruction using a 4K three-dimensional exoscope system (VITOM 3D). Int J Oral Maxillofac Surg 49:1169\u20131173. https:\/\/doi.org\/10.1016\/j.ijom.2020.01.022","journal-title":"Int J Oral Maxillofac Surg"},{"key":"2551_CR7","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1159\/000100285","volume":"63","author":"PL Gildenberg","year":"1994","unstructured":"Gildenberg PL, Ledoux R, Cosman E, Labuz J (1994) The exoscope\u2013a frame-based video\/graphics system for intraoperative guidance of surgical resection. Stereotact Funct Neurosurg 63:23\u201325. https:\/\/doi.org\/10.1159\/000100285","journal-title":"Stereotact Funct Neurosurg"},{"key":"2551_CR8","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/0003-6870(93)90080-s","volume":"24","author":"L Mcatamney","year":"1993","unstructured":"Mcatamney L, Nigel Corlett E (1993) RULA: a survey method for the investigation of work-related upper limb disorders. 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Since this is an observational study about the conduction of surgery using an approved medical device. Thus no ethical approval was required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all subjects (patients and surgeons)\u00a0involved in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and\u00a0Informed consent\u00a0"}},{"value":"The authors affirm that human research participants provided informed consent for publication of their cases and\u00a0of the images in Figs.\u00a0\n                      \n                      ,\n                      \n                      ,\n                      \n                      and\n                      \n                      .","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"391"}}