A Tubular-Mounted Digital Camera (TMDC) versus Optical Surgical Microscope (OSM) for Minimally Invasive Lumbar Decompression Surgery: The impact on Operative Times, Ergonomics, and Workflow

OBJECTIVES:Understanding the ergonomic impact is foundational to critically evaluate the value and safety of enabling technologies in spinal Minimally Invasive Spine Surgeries (MISS). This study assessed the impact of tube-mounted digital camera (TMDC) vs. optical surgical microscope (OSM) in single-level MISS on operative times, durotomy rate, surgeon ergonomics, safety, and operating room workflow. METHODS:In a retrospective study, we compared consecutive single-level MIS lumbar decompression surgeries with TMDC (Sep 2021-Jun 2022) to a historical OSM cohort (Jan 2020-Jul 2021). Data included patient demographics, operative times, durotomy incidence, surgeon ergonomics (REBA scores), and equipment impact via staff surveys. T-tests assessed operative times, while Pearson chi-squared tests compared sex. Age, BMI, and CCI comparisons used Wilcoxon rank-sum tests, and survey results were analyzed with Wilcoxon signed-rank tests. RESULTS:In total, 74 and 82 patients were included in the TMDC and OSM groups, respectively. Age, sex, and CCI did not significantly differ between both groups. The TMDC group had a higher BMI (29. 6 ± 5.1) versus the OSM group (29.0 ± 7.5) (p=0.04). The TMDC group (n=74) had significantly shorter operative times (57.3±16.6 minutes) compared to the OSM group (n=82) (66.7±22.5 minutes) (p=0.004), with no difference in durotomy rates (p=0.42). TMDC use yielded lower REBA scores (3) vs. OSM (4.1±0.77) (p<0.001). Surveys indicated improved safety, setup time, and workflow with TMDC (p<0.001). CONCLUSIONS:TMDC in single-level MIS lumbar decompression surgery improved surgeon ergonomics, reduced operative times, and maintained durotomy rates, enhancing operative room efficiency. Evaluating technology's ergonomic impact is vital for safety and value assessment.