Application of the VITOM 3D exoscope in reconstructive microsurgery

Abstract Introduction: To assess the quality of the Video Telescope Operating Monitor digital 3-Dimension (VITOM 3D) system and the primary results achieved after applying this system for soft tissue defects in reconstructive surgery at Hue Central Hospital (Viet Nam). Patients and methods: We studied 82 patients (88 free flaps) with ages ranging from 7 to 80 years old undergone the soft tissue and bone defects reconstruction using VITOM 3D exoscope, from March 2019 to August 2022. We used the perspective study and the patients were researched on the properties of injury, on the kinds of flap or procedures, on sizes of flap or vessel, numbers of anastomosis, and on the results of surgery. Results: In 82 patients with 88 free flaps we used in this study there included 72 Anterolateral Thigh Flaps (ALT) (81.8%), 7 Superficial Circumflex Iliac Perforator Artery Flaps (SCIP) (7.9%), 5 Latissimus Dorsal Flaps (LD) (5.6%) and 4 Fibular free flaps (4.5%). There were 72/88 flaps reaching Good level accounting for 81.2%, 12/88 flaps (15.9%) were at Average, 3/88 flaps (3.4%) were at Bad level due to being partial necrosis and 1 flap being failed with flap necrosis due to infection with MRSA. There were total 93 arterial and 146 vein anastomoses, respectively (on average: 2.7 anastomoses/flap). With the support of VITOM 3D system, we manipulated the arteries and veins having calibers is 2.4 ± 0.5 mm and 1.9 ± 0.4 mm on average, respectively. No anastomosis site complication was and the operative time in average 4.6 hours (ranging from 3 hours to 7 hours).. Conclusion: We have updated and applied day by day widely, not just in the neurosurgery field, but also in reconstruction microsurgery. The primary results showed the efficiency and practicability of exoscopic 3D technique for soft tissue defect microsurgical treatment. The VITOM 3D system becomes more popular in both treatment for patients and training for students. However, we need to remember that the traditional Operating Microscope (OM) still keeps its valuations so further studies are needed to validate the advantages and disadvantages of VITOM 3D as compared to OM. Keywords: VITOM 3D, operating microscope (OM), microsurgery.