Exoscope Technology and the Evolution of Otologic Surgery at UHealth
A high-definition exoscope is reshaping ear surgery at UHealth, where Dr. Juan Chiossone-Kerdel has replaced the operating microscope with the digital, heads-up system that enhances visualization, ergonomics and surgical training.
For decades, otologic surgery has relied on the operating microscope. The tool places the surgeon’s eyes directly into the surgical field. Now, a superior technology is reshaping that paradigm.
At the University of Miami Miller School of Medicine, Juan Armando Chiossone-Kerdel, M.D., is helping lead the transition.
An exoscope is an external, high-definition digital imaging system that offers a fundamentally different way to visualize surgery. Instead of looking through binocular eyepieces, surgeons operate while viewing a magnified, three-dimensional image on a screen.
“The exoscope is not a microscope, because your eyes are not in the scope,” said Dr. Chiossone Kerdel, an associate professor of otolaryngology—head and neck surgery at the Miller School and director of the Cranial Access Neuroanatomy and ENT Surgical Laboratory (CANES Lab). “But it’s not an endoscope, either. You are actually watching the screen while you operate, but you get a stereoscopic view that is more or less the same you have with the microscope.”
A Shift from Microscope to Exoscope in Ear Surgery
What began as an exploration of emerging technology has quickly become a central part of Dr. Chiossone-Kerdel’s clinical work. He has replaced the traditional microscope with the exoscope for all of his ear surgeries.
“I’m using it now for every single patient,” he said. “I replaced the microscope completely with this technology.”
The shift reflects both practical advantages and a broader vision for the future of surgery. Compared with conventional microscopes, exoscopes are more compact and flexible. That facility allows surgeons to position the camera at angles that are difficult or impossible with traditional equipment.
“It gives you a degree of freedom,” Dr. Chiossone-Kerdel said. “These devices are much smaller than the conventional operating microscope, and you can put them essentially in any position.”
The result is a more ergonomic surgical experience, with surgeons able to work in a “heads-up” posture rather than maintaining fixed positions required by microscope eyepieces. That reduces musculoskeletal strain on the surgeon, which can only help the surgeon’s performance during surgery.
Impact on Surgical Education
Beyond its clinical use, the exoscope is changing how surgery is taught. The shared 3D view invites everyone in the operating room, from medical students to residents, to see exactly what the surgeon sees, in real time.
“It’s a perfect tool for education. Anybody in the room wearing the glasses will be able to see exactly the same image as the surgeon,” Dr. Chiossone-Kerdel said. “That doesn’t happen with a microscope.”
This capability creates a powerful educational environment, allowing trainees to follow the procedure more intuitively and understand surgical decision-making as it happens. The technology can also be transmitted remotely, opening the door to expanded training opportunities beyond the operating room.
“It’s part of the future,” said Dr. Chiossone-Kerdel. “We as surgeons need to train with these technologies. This is one arm of what will become full, robotic ear surgery.”
What Simulation Research Reveals About Exoscope Use
To better understand how surgeons learn and perform with exoscopic systems, Dr. Chiossone-Kerdel, as principal investigator, collaborated with UM medical students and residents on a study published in Laryngoscope Investigative Otolaryngology that compared exoscopes with traditional operating microscopes in simulated ear surgery.
The prospective study involved 14 medical students and 15 otolaryngology residents. The participants completed five standardized tasks using both visualization systems on 3D-printed ear models.
Dr. Chiossone-Kerdel and colleagues evaluated task completion time, errors, mental effort and user experience. The results revealed that, while participants often completed tasks faster using the operating microscope, there was no consistent difference in accuracy or perceived difficulty between the two systems.
Crucially, the findings highlighted differences based on experience level. Residents who were already trained with microscopes tended to favor the traditional approach and performed tasks more quickly with it. In contrast, medical students, many of whom had little prior exposure to microscopes, showed greater favorability toward the exoscope.
Among all participants, 89% rated the ergonomics of the exoscope as superior. Students frequently cited improved visualization and ease of repositioning as advantages.
The study concluded that “the exoscope permits successful performance in simulated otologic tasks” and that differences in performance were strongly influenced by prior training rather than inherent limitations of the technology.
Preparing for the Future of Digital and Robotic Surgery
For Dr. Chiossone-Kerdel, the exoscope is a technology that serves as a critical step toward digital surgical systems that will improve as the surgeons ply their trade. The data they generate could be used to enhance navigation, guide decision-making and support future integration with artificial intelligence.
Dr. Chiossone-Kerdel’s work at the Miller School demonstrates how innovation moves from laboratory research to patient care. The real impact lies in using technology for better training and better patient outcomes.
“It’s great because you see how research translates to patients and to patient care,” he said.
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Tags: CANES Lab, Department of Otolaryngology, Dr. Juan Armando Chiossone-Kerdel, otolaryngology, Otology & Neurotology, surgery, technology