Heads-up surgery: More options for better outcomes

October 2, 2020

Heads-up surgery is moving into the next generation of vitreoretinal surgery, with novel technologies being developed for surgeons.


Novel technologies are being developed for vitreoretinal surgeons with the goal of improving visualisation of these complex surgeries in delicate tissues. One such system that Prof. Anat Loewenstein and Prof. Joseph Moisseiev are reporting about is the NGENUITY 3D Visualisation System (Alcon), which has a number of attractive features.

“This technology digitally improves visualisation during vitreoretinal surgeries,” they said.

They explained that two high dynamic range cameras capture the image from the patient’s eye with excellent resolution, image depth, clarity and colour contrast, and the image reproduces large differences in brightness to retain the details in the light and dark areas.

The image is processed by a central processing unit and displayed on a large viewing monitor, which eliminates the need for the surgeon to look through a microscope.

A display, which measures 55 inches and has a 1,920 X ,2160 pixel resolution per eye (8 million pixels), is on a stand that allows movement of the monitor in the X, Y and Z planes in addition to rotational movement. Polaroid glasses are available for the surgeon and observers.

Prof. Loewenstein noted that most surgeons reported that the ergonomics of this system were superior to those of the standard surgical microscope, and that the digital image processing and use of a large display are significant advantages.

The heads-up display may also be used in conjunction with intraoperative optical coherence tomography to combine the advantages of both technologies.

The educational value is apparently the greatest advantage of this 3D system.

“All of the staff members present in the operating room have exactly the same 3D view and depth perception as the surgeon; the observers can watch every step and maneuver and fully understand what is going on during the procedure. The ability to transmit this 3D view to monitors and screens outside the operating room is a very valuable tool for live-surgery meetings,” Prof. Lowenstein said.

Another system that is noteworthy is the Beyeonics One (Beyeonics), which is not yet commercially available. This is the first surgeon-centred surgical visualisation and information system.

The system comes equipped with a head-wearable display, ultra-resolution cameras with x10 HD resolution and true 3D capability, and software applications that facilitate the surgeon’s ability to access unlimited information in the direct field of view. The displayed image adjusts to the positioning of the surgeon’s eye and provides high-quality central and peripheral images.

The head-mounted display is similar to that used by pilots to display flight data, videos and symbols that are critical for flight. Head gestures allow surgeons to, for example, flip screens, control focus and zoom in and out.

Multiple virtual displays can be virtually positioned anywhere in the operating room and customised for each surgeon. The device provides real-time data accessibility from optical coherence tomography, wavefront and applications.

Image quality is 4K 3D display and the image size is 70 inches in 2 meters . Surgeons can use their personal glasses.

The ultra-resolution cameras capture and magnify the entire field of view all the time. Image enhancement improves visualisation and ability to see the invisible, while the high sensitivity reduces illumination levels and the significant decrease in light levels reduces light toxicity.

More than 200 successful surgeries have been performed using these advanced technologies in Israel and the United States that include vitrectomy, endolaser treatment, membrane peeling, retinal detachment, cataract surgery and removal of lens fragments, Prof. Loewenstein reported.

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Affiliations
Anat Loewenstein, MD

anatl@tlvmc.gov.il
Prof.Loewenstein is professor of ophthalmology and deputy dean of the medical school at the Sackler Faculty of Medicine, Tel Aviv University, and the Department of Ophthalmology, Tel Aviv Sourasky Medical Center in Tel Aviv, Israel.
Prof. Loewenstein is a consultant to Beyeonics and Prof. Moisseiev does not have any financial interest in this subject matter.

Joseph Moisseiev, MD, is associate clinical professor of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, and former Israel Director of the Department of Ophthalmology, The Goldschleger Eye Institute, The Sheba Medical Center, Israel.