<p>Consolidation of Imaging Modalities Utilizing Digitally Assisted Visualization Systems: The Development of a Surgical Information Handling Cockpit</p>

Abstract

The management of vitreoretinal cases is ever-evolving, paralleled by rapid advancements in operative imaging modalities. In this article, we describe an advanced application of digitally assisted vitreoretinal surgery (DAVS) that involves the consolidation of pre-existing ancillary imaging technology into a single same-screen viewing platform. Forty-four eyes of 44 patients were operated using same screen simultaneous viewing of the primary three-dimensional high definition (3DHD) surgical field and simultaneous auxiliary video feed viewing of all currently approved ocular endoscopy (n=12), intraoperative optical coherence tomography (iOCT) units (n=24), or computer feeds from the EHR/image management software (n=8). All surgeries were successful with excellent functional and anatomic outcomes. DAVS facilitated same screen viewing of multiple video/information feeds was notable for improved ergonomics, surgical efficiency, and precision when compared to viewing the surgical field and auxiliary video feeds separately. We describe a new concept for the vitreoretinal operating rooma DAVS-based surgical information handling cockpitintegrating FDA approved ocular endoscopy (n=1), microscope-integrated iOCT units (n=3), and one EHR/Image management solution with the primary surgical field 3DHD feed. We suggest same screen viewing of multiple video and other clinical information feeds is a promising modality that may be considered in the management of patients with surgical vitreoretinal disease and should be purposefully incorporated into future iterations of DAVS technology platforms.

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review

“…To address this issue, device manipulation by voice commands has been developed to change the MI-OCT scan location [ 130 ]. Brooks et al merged ancillary imaging technology into a single-screen viewing platform to improve intraoperative interpretation (named digitally assisted vitreoretinal surgery, DAVS) [ 131 ]. In particular, it is a high-definition visualization system displaying the surgical field in real-time, as well as imaging from MI-OCT, ocular endoscopy, and electronic health records/imaging, onto a 3D High-Definition flat-panel screen (NGENUITY™, Alcon.…”

“…Fort Worth, TX, USA). This prototype is more user-friendly, more ergonomic, and conveys more precise information, compared to image visualization on different displays [ 131 ]. In particular, surgeons reported a significant lower rate of back discomfort and headaches, compared to the conventional MI-OCT visualization system: 1.0% vs. 18.7% ( p < 0.0001) for back pain and 5.2% vs. 20.9% ( p < 0.002) for headaches, respectively [ 132 ].…”

A Survey of Medical Visualization through the Lens of Metaphors

“…According to the metaphor, surgical cockpits aim at the integration of all control facilities in a single place. Thus, the more precise term surgical information handling cockpit is also employed [22]. A surgical cockpit was first described by Hori et al [61].…”

Comparison of Two Three-dimensional Visualization Systems: A Consecutive Series and Descriptive Analysis of 296 Cases

“…The key features of the NGENUITY and ARTEVO 800 are summarized in Table 1 [4,8,9,[20][21][22][23][24]. The primary differences between the two DAVSs are the camera chipset, camera resolution, and HDR.…”

“…Among the DAVSs employed, the NGENUITY 3D Visualization System (Alcon, Fort Worth, TX, USA) is familiar to many vitreoretinal surgeons; however, few articles have been published regarding its application [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The ARTEVO 800 (Carl Zeiss Meditec, Dublin, CA, USA) was introduced in 2019 and has been recently featured as an integrated digital optics.…”