Laboratory Evaluation of a Robotic Operative Microscope - Visualization Platform for Neurosurgery

Abstract

BackgroundWe assessed a new robotic visualization platform with novel user-control features and compared its performance to the previous model of operative microscope.MethodsIn a neurosurgery research laboratory, we performed anatomical dissections and assessed robotic, exoscopic, endoscopic, fluorescence functionality. Usability and functionality were tested in the operating room over 1 year.ResultsThe robotic microscope showed higher sensitivity for fluorescein sodium, higher detail in non-fluorescent background, and recorded/presented pictures with color quality similar to observation through the oculars. PpIX visualization was comparable to the previous microscope. Near-infrared indocyanine green imaging 3-step replay allowed for more convenient accurate assessment of blood flow. Point lock and pivot point functions were used in dissections to create 3D virtual reality microsurgical anatomy demonstrations. Pivot point control was particularly useful in deep surgical corridors with dynamic retraction. 3D exoscopic function was successfully used in brain tumor and spine cases. Endoscopic assistance was used for around-the-corner views in minimally invasive approaches. We present illustrative cases highlighting utility and new ways to control the operative microscope.ConclusionImprovements of the robotic visualization platform include intraoperative fluorescence visualization using FNa, integrated micro-inspection tool, improved ocular imaging clarity, and exoscopic mode. New robotic movements positively assist the surgeon and provide improved ergonomics and a greater level of intraoperative comfort, with the potential to increase the viewing quality. New operational modes also allow significant impact for anatomy instruction. With the increasing number and complexity of functions, surgeons should receive additional training in order to avail themselves of the advantages of the numerous novel features.

Progress in Confocal Laser Endomicroscopy for Neurosurgery and Technical Nuances for Brain Tumor Imaging With Fluorescein

“…The Gen2 CLE device was designed to function specifically for intraoperative application in neurosurgery and to integrate with the robotic operating microscope visualization platform for neurosurgery (22). The goals for this device in neurosurgery are ultimately to increase the positive yield of biopsies and to serve as a tool to microscopically explore, in portable and rapid fashion, for tumor cells beyond the obvious margin of infiltrating tumors, such as cells in and around the surgical resection bed, or to define suspected tumor invasion within eloquent cortex.…”

Application of a three-dimensional high-definition exoscope in minimally invasive transforaminal lumbar interbody fusion

“…Besides, although most neurosurgeons today are accustomed to an operative microscope, there is certainly a learning curve necessary before using the exoscope in spinal surgery. Belykh et al [26] reported a signi cant learning curve exists for becoming accustomed to operating with the exoscope system. No doubt it could be a potential issue for operators who are not familiar with the comparable microscope setup.…”

Development of a Simulation Model for Fluorescence-Guided Brain Tumor Surgery

“…Fluorescein is a bright yellow fluorophore used off-label for tumor labeling in neurosurgery, with a growing body of evidence suggesting that its use improves achievement of gross total resection (37–39). Advanced illumination capabilities of the latest operating microscopes allow neurosurgeons to work directly under the Yellow 560 filter throughout the tumor resection (40).…”