Results: Seventy-five patients (55.1%) underwent exoscopic clipping. The patient characteristics were similar between the two groups. There were no significant differences in the setup time (63 min vs. 62 min; P=0.120), operative time (295 min vs. 304 min, P=0.990), rate of surgical complications (5.3% vs. 3.3%, P=0.691), or favorable outcomes (97.3% vs. 95.1%, P=0.657) between the two groups. In the postoperative questionnaire evaluation, the exoscope received higher scores in terms of “image quality”(78.9%), “brightness” (84.2%), “operability” (73.7%), and “education” (57.9%). In contrast, the conventional microscope received higher scores in terms of “assistant work” (73.7%).