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BLOG: Surgeons should adopt heads-up surgery
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The ophthalmic community is getting more involved in “heads-up” surgery – the use of cameras and 3-D monitors to visualize surgery instead of a traditional optical microscope.
I have had extensive experience with the TrueVision 3-D system in my operating room between about 2013 and 2014. This same system has since been further updated and is now being sold by Alcon as the Ngenuity system.
As a user of the predecessor system back then, I was quite impressed by its ability to display an image of the eye on a 3-D monitor. Wearing polarized glasses and after a fairly short learning curve, I felt comfortable completing most procedures, including cataracts, using the screen alone and not looking through oculars. Depth of focus is quite remarkable, and it produced stunning recordings, including one that earned me an ASCRS Film Festival Award on pterygium surgery.
Ultimately, I stopped using this system because the resolution available in 2014 was not as good as an optical scope, and there was about 50 milliseconds of latency in the image that, while not problematic, was a bit annoying compared with a traditional scope.
Today’s Ngenuity system has much less latency, about 15 milliseconds, and even better resolution. We are now at a point where these microscope systems essentially equal the visualization with an optical scope, which is a great advantage for surgeons with neck and back problems. Thankfully, I have none so far, but sitting upright rather than leaning forward to operate is a much more relaxed posture for anyone.
What’s even more exciting about heads-up surgery is the potential for integration with new technology that is already being realized. Applying side screens or overlays can show surgeons the optimal capsulorrhexis size, the axis of predetermined astigmatism and intraoperative aberrometry measurements. Developing technologies, like intraoperative OCT, can give surgeons a 3-D sense of anatomy that ordinary light cannot provide. Augmented reality could be used to highlight in color information such as fluid flow and pressure in the eye while perhaps warning surgeons of post-occlusion surge or other dangers before they occur. Like vehicles with early warning collision systems help even experienced drivers, such systems could be valuable to all of us but particularly to new surgeons.
Think of it this way: As long as we use an optical microscope, surgery can be no more high-tech than the surgeon’s brain allows. When a 3-D digital imaging system is involved, we can harness the power of artificial intelligence to assist us. Surely, robotic surgery cannot be too far down the road, and we surgeons, putting our patients’ interests first, should welcome these incremental steps that get us there.
Disclosure: Hovanesian reports he is a consultant for Alcon and TrueVision.