Technological refinements in transoral laser exoscopic surgery: the VITOM EAGLE

Traditionally, microscopes have been the primary magnification tools in head and neck surgery, offering excellent illumination, augmentation, and three-dimensional (3D) visualisation. More recently, exoscopes such as the VITOM 3D from Karl Storz, have emerged. These devices utilise high-definition cameras to project 3D views onto a screen, enabling the entire surgical team to observe the procedure while the first operator assumes a more ergonomic position during surgery. VITOM 3D enhances surgical accuracy and team collaboration, although it presents challenges including difficulties with focus at high magnification and less stable coupling with adjunctive tools. To address these limitations, the VITOM EAGLE exoscope was recently introduced. Weighing 4 kg, it features a 6X optical and 2X digital zoom, 4K resolution, stepless focus adjustment, and a 90° viewing angle. It offers improved ergonomics even compared to the previous VITOM 3D, better laser coupling stability, and enhanced visualisation capabilities, especially at higher magnification. The VITOM EAGLE’s controls include an IMAGE1 PILOT, footswitch, and head buttons, managing functions like focus, zoom, brightness, and image capture. Despite its advancements, some details, like the smoothness of the robotic arm, still require refinement. In our clinical practice, several cases were managed with the use of the VITOM 3D and, more recently, with VITOM EAGLE, some of which are illustrated herein.