3-D Hi-Def Microscope
May 7, 2009DrHovanesian No Comments »3-D High Definition Microscope Changes Surgery, Sets Stage for Computer Aided Surgery
Here is a new technology I am particularly excited about.
 Dr. Robert Weinstock performing cataract surgery using the TrueVision 3D Microscope. |
Most of us are not old enough to have practiced in the era of doing cataract surgery while wearing loupes. Those who lived through the transition to surgical microscopes tell how much easier surgery became with this amazing new tool for visualization. I recently came to understand what they must have felt when I did my first surgical procedures using a new 3D high-definition video system called True Vision.
The system is really simple. It consists of a two-camera system mounted to the eyepieces of a your standard surgical microscope. It can be attached to the assistant’s “side scope” as long as the assistant’s eye pieces have true stereo. The camera’s output is displayed on a screen held on a cart directly adjacent to the operating table. The surgeon (and his staff) wear 3D polarizing glasses, and instead of viewing the surgery through the microscope, he or she operates while watching the screen.
Now, on the surface this might seem like just a toy for über-geeks with healthy checking accounts, but there are a number of major advantages over using a standard surgical microscope.
First, think about the ergonomics. How often do surgeons go home with a sore neck or back from hours of craning over a gurney to reach the microscope’s oculars? Operatiing with this projection system, surgeons can sit in a perfectly upright position for hours, completely free of back strain. Priceless.
Second, consider the advantages for teaching, assisting or learning on a system where every observer has a view that is identical to the surgeon’s. How much easier will it be for residents to understand the subtle geometry of capsulorhexis or nucleus removal in cataract surgery if they can appreciate the movements in three dimensions? How much simpler will it be to lend a hand from the side to a learning resident if you, the teacher, have exactly the same view? Some leading training programs around the country are already employing this type of 3D surgery system.
Finally, consider the possibilities of “computer-aided surgery”. A photo of the undilated eye, taken before surgery can be overlaid on the dilated eye during cataract surgery. Using already-available image recognition software, this partially-transparent overlay can be kept in real-time alignment with the moving eye being operated on, allowing perfect centration of a multifocal IOL. For limbal relaxing incisions, a different overlay image can tell us exactly where to make incisions, taking into account cyclorotation that occurs in patients moving to a supine position. Instead of marking tissues with ink (which is just so last year!), on-screen reticles and guides can be turned on or off to show retina surgeons where to use an MVR blade, cornea surgeons where the geometric corneal center is, pediatric surgeons where to pass a scleral suture. This type of overlay or picture-in-picture display is already being used with 3D cameras in leading neurosurgery centers, allowing localization of brain lesions that are only visible on MRI, PET scan, or even multiple modalities at once. The possibilities in eye surgery are only beginning to be discovered.
I encourage readers’ thoughts and questions on the use of this technology.
Editor’s note: Dr. Hovanesian has no financial interest in the microscope system described here.
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