Microvascular anastomosis in head and neck free flap reconstruction using the RoboticScope

Many different technologies are currently being used for surgical field magnification during microvascular anastomoses, including the operative microscope (OM), surgical loupes and the exoscope. The OM is probably still the most widely used technology to perform microvascular anastomoses, owing a high-quality image thanks to its optical magnification. However, the OM can be cumbersome and often obliges the surgeons in uncomfortable positions, leading to musculoskeletal discomfort in the neck, shoulders and back. In this setting, the use of the exoscope to perform microvascular anastomoses has been described in the literature, permitting a more ergonomic posture to the operators, but vitiated by a reduction of the image quality during high magnification of the surgical field due to its digital zoom. Recently, the RoboticScope (BHS Technologies GmbH, Innsbruck, Austria) has been introduced as a new magnification tool in cochlear implant surgery and neurosurgery.