Exoscope-assisted orbital fracture reduction surgery—Clinical assessment by surgeons: A retrospective cohort study

Background: Exoscope-assisted digital imaging allows continuous real-time visualization of the surgical site on a large 3D monitor. We evaluated its usefulness in orbital fracture reduction surgery, a procedure with a narrow and deep operative field that restricts direct visibility for the operating surgeon. Methods: This retrospective cohort study included all patients who underwent orbital floor fracture reduction with an absorbable plate via a subciliary approach at our institution from January 2022 to December 2024. ORBEYE 3D exoscope system (Olympus, Tokyo, Japan) was used in all cases when available, as the device was shared among several departments in our institution. Surgeries performed with and without the ORBEYE exoscope were compared for the following preoperative variables: (i) years since the surgeon's graduation and (ii) days from injury to surgery, and outcome variables including (iii) operative time, (iv) blood loss, and (v) absorbable plate size. Surgeons also completed a questionnaire regarding their experience with ORBEYE. Results: Eleven patients underwent conventional surgery, and 10 underwent ORBEYE-assisted surgery. ORBEYE-assisted surgery resulted in a significantly shorter operative time, while no significant differences were observed in other preoperative or outcome variables. The involved surgeons reported reduced physical strain, particularly in the neck, as well as improved collaboration and education. Despite some disadvantages, all surgeons expressed a positive attitude toward continued ORBEYE use. Conclusions: ORBEYE-assisted surgery offers significant advantages in orbital floor fracture reduction, including reduced operative time, improved ergonomics, and enhanced teamwork and education. Its drawbacks are relatively minor, and broader adoption in plastic surgery should be considered.