Application of a 3D 4K exoscopic system to head and neck reconstruction: a feasibility study

Background: Technological advancements in surgery provide convenience and new capabilities to surgical practice. A recently developed 3D 4K exoscopic system gives the surgeon a potential alternative to the operating microscope (OM). This paper focuses on the first experience on microsurgical free flap reconstructions performed with a 3D 4K system and evaluates the potentials and pitfalls of this new technology. Methods: Three consecutive cases of head and neck cancers requiring free flap reconstructions were included. Free flap harvesting and anastomosis in 2 and 3 patients, respectively, were performed using the 3D 4K exoscopic system. Results: The 3D 4K exoscope provided a high quality of vision and perception of depth. The setting of the operating theater was ergonomically favorable. No case required a switch to traditional OM. Conclusions: This initial experience shows that harvesting free flaps and performing microanastomoses with the 3D 4K exoscopic system are feasible. Further studies on larger series are warranted to explore if the applicability of this technology to other fields of head and neck surgery can compensate for its costs. Level of Evidence: Level V, therapeutic study.