Identification of the optimal visual recording system in open abdominal surgery–a prospective observational study

Introduction: Current methodologies used to record and render the surgeon’s point of view in open operative surgery remain limited. Chief among these limitations is a failure to demonstrate, in high definition and magnification, the planar roadmap that surgeons utilise in colorectal surgery. The high magnification and high resolution views provided during laparoscopic surgery simultaneously capture the planar road map and surgeon’s point of view. We developed an arm-mounted external laparoscope (exoscope) system and compared its performance against multiple standard recording modalities. Methods: Following ethical approval and informed consent, open colorectal procedures were recorded using five separate methodologies. Each methodology was assessed and compared. Results: Most of the methodologies utilised scored poorly at one if not more levels. The arm-mounted external laparoscope (exoscope) scored highest in rendering the surgeon’s point of view while simultaneously achieving high resolution and high magnification rendition of operative field (p <.001). This methodology was tested in a number of operative contexts within which it reproducibly and consistently scored highly. Conclusions: The arm-mounted exoscope is the optimal means of rendering the surgeon’s point of view of anatomic planes during open colorectal surgery.