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MUSC Health First in SC to Offer New Technology for Minimally Invasive Neurosurgery for Spine and Brain

Advance With MUSC Health
July 19, 2021
Once used at the international space station to move cargo and astronauts, the technology, a 3D exoscope and a robotic arm, is a high-powered digital imaging system.

MUSC Health is the first in the state to offer a revolutionary technology that is quicker, requires less time under anesthesia and speeds recovery for brain and spine surgery patients.

Once used at the international space station to move cargo and astronauts, the technology, a 3D exoscope and a robotic arm, is a high-powered digital imaging system. It transfers magnified images of the surgical site onto a 55-inch screen that can be viewed by the surgical team in real time.

Dr. Sunil Patel

Dr. Sunil Patel, professor and chairman of MUSC's Department of Neurosurgery and the holder of the Jerry Zucker Endowed Chair in Brain Tumor Research, calls the exoscope "revolutionary" and a game-changer for the way brain and spine surgery are performed.

"The exoscope is the future of spine and brain surgery," Patel says. "This technology has improved our ability to do neurosurgery of the brain and spine. My hands are doing the surgery guided by the imagery on the screen."

Think of the old-fashioned microscopes some of us hunched over in high school biology to study and dissect earthworms and fetal pigs. Then imagine a huge microscope, mounted on a robotic arm on top of a cart, that can display images to guide the surgeon with precision unparalleled in spine and brain surgeries until a few years ago.

"The exoscope's precision provides important advantages for the patient and the surgeon," Patel says. "It vastly improves visualization, which allows me to make microscopic openings instead of larger incisions at the surgical site. A smaller incision means less pain for the patient and a quicker recovery time. Moreover, because a procedure can be done more efficiently -- shaving off 30 percent of the time for traditional surgery -- patients spend less time under anesthesia."

Patel says the 3-D magnification provides increased confidence because it enables him to see and avoid critical structures in the brain and the spine and preserve adjacent micro-anatomic structures, thus minimizing the risk for complications. And because the procedure is displayed on the big screen, he doesn't have to twist and bend to look through a traditional operating microscope during the surgery. Instead, he is watching the screen and being guided by the exoscope's robotic arm.

On a recent day, Patel used the exoscope technology to perform an anterior cervical discectomy and fusion on a patient, a procedure in which a disc is removed and replaced with bone graft or an implant to relieve pressure on the spine.

Once the patient was anesthetized, Patel made a very small incision in the anterior, or front, of the patient's neck. After he had opened the site, the exoscope on a robotic arm was rolled next to the surgery table and positioned over the surgical site. Patel and his team donned 3-D goggles, turned to the big screen and concentrated on the images on the screen as the robotic arm guided the team. Four other smaller screens displaying the same images were placed around the table for the team.

In slightly more than an hour, the surgery was complete. The disc had been removed successfully, and the fusion completed. Soon, the patient was fully awake and talking.

Patel, who has been performing microneurosurgery for more than 30 years, says this technology has a "wow factor" unlike any tech development in surgery since he began practicing medicine.

"This is a completely different type of technology. Images can be loaded prior to surgery so our team can study them, and images can be superimposed on the surgical site. I have been tracking the development of exoscopy for about 10 years, and now it has finally come to fruition. It is almost surreal, and it's definitely spectacular."

The exoscope is the latest among several technologies used by MUSC Health neurosurgeons to move to the age of minimally invasive surgery of the spine and brain. Endoscopic spine surgery was introduced more than 5 years ago, in which endoscopes are used to perform spine surgery in select pathologies of the spine. Incisions the size of a few millimeters are used to remove herniated discs and decompress spinal nerves. Image-guided tubes are used to perform a variety of brain operations through small incisions in the scalp. Endovascular neurosurgeons perform cerebral aneurysm repair though catheters introduced through blood vessels.

"As these technologies are refined, MUSC Health will remain a leader as neurosurgery moves to increased use of robotics for spine and brain surgery," Patel says.

To make an appointment with Dr. Patel, call 843-792-7700 or visit his profile.