<p>The Scope Of Three-Dimensional Digital Visualization Systems In Vitreoretinal Surgery</p>

Abstract

IntroductionSignificant advances in three-dimensional (3D) imaging technology have allowed for the incorporation of 3D digital displays into medical and surgical devices. Despite initial adoption of the NGENUITY® 3D Visualization System in vitreoretinal surgery, there are limited publications regarding its use. The generally accepted main benefits include improved ergonomics, enhanced surgical team communication and education, reduced retinal phototoxicity, increased depth of field, and display image manipulation. Despite these potential benefits, many retina specialists have questioned its universal applicability to a wide variety of vitreoretinal surgeries.ObjectiveTo report on the variety of indications and surgical efficacy of the NGENUITY® 3D Visualization System in vitreoretinal surgery via a review of surgical experience at two vitreoretinal practices in both the academic and community settings.MethodsA retrospective review was conducted of consecutive surgical cases performed on the NGENUITY® 3D Visualization System at Massachusetts Eye and Ear Infirmary and Florida Retina Institute from June 1st, 2017 to November 1st, 2018. Age, presenting diagnosis, surgical procedure, and intraoperative details were recorded.Results272 vitreoretinal surgeries on the Alcon NGENUITY® 3D Visualization System were identified between June 1st, 2017 and November 1st, 2018 at the participating institutions. A detailed breakdown of the indications for surgery and related procedures is reported. During all 272 cases on the 3D digital system, there were no complications attributed to the visualization system.ConclusionThis series illustrates the diversity of vitreoretinal surgeries that can be performed on this system without compromising surgical viewing or increasing surgical complications. The Alcon NGENUITY® 3D Visualization System possesses favorable ergonomics, illumination levels, depth of field, display filters, and trainee experience.

Can the Three-Dimensional Heads-Up Display Improve Ergonomics, Surgical Performance, and Ophthalmology Training Compared to Conventional Microscopy?

“…Our results were consistent with a previous report by Agranat et al, which showed that peripheral acuity through HUD is at least good as conventional microscopy. 10 Our results also indicate no issue with integrating the HUD system with the currently used equipment, eg, vitrectomy machine and forceps. Also, two-third of the HUD users found the device technically feasible.…”

“…Consistent with previously published studies, most of our participants believed that the HUD system provides better depth perception than traditional microscopy. 6–8 , 10 , 18 Visualization of peripheral retina is critical during vitreoretinal procedures, especially during vitreous base shaving near the ora serrata and during peripheral retina examination before concluding the surgery. Our results were consistent with a previous report by Agranat et al, which showed that peripheral acuity through HUD is at least good as conventional microscopy.…”

The User Experience on a 3-Dimensional Heads-Up Display for Vitreoretinal Surgery Across All Members of the Health Care Team: A Survey of Medical Students, Residents, Fellows, Attending Surgeons, Nurses, and Anesthesiologists

“…This may reflect their extensive experience performing vitreoretinal surgery with the standard microscope and the learning curve associated with a new tool. 12 As an example, graduated fellows who proceeded to use the Ngenuity regularly in their postfellowship practice reported higher satisfaction with the system. Additionally, although most respondents expressed a high comfort level with the heads-up display, there has been some speculation that the ergonomics are unnatural for assisting surgeons, who may be forced to turn their head 90 for some steps of the surgery.…”

“…Finally, given their primary role in the surgical procedures, fellows and attendings may be more affected by the decreased visibility in the peripheral retina that has been reported. 12 This could be addressed with additional experience as well as attention to fine focus and intraocular lighting to improve peripheral views on this platform.…”

A guarded light pipe for direct visualization during primary scleral buckling on the Ngenuity platform

“…The procedure was performed using the Ngenuity digital three-dimensional (3D) visualization system [ 4 ] which relays overlapping real-time video obtained from the surgical microscope into a display monitor at the foot of the patient’s bed; stereopsis is appreciated when the surgeon, assistants and nursing team wears polarizing glasses. A peritomy was performed to expose the sclera.…”