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

Authors

Evgenii G. Belykh, Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Xiaochun Zhao, Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Claudio Cavallo, Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Michael A. Bohl, Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Kaan Yagmurlu, Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , USA.Follow
Joseph L. Aklinski, Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Vadim A. Byvaltsev, Neurosurgery, Irkutsk State Medical University, Irkutsk, RUS.
Nader Sanai, Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Robert F. Spetzler, Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Michael T. Lawton, Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Peter Nakaji, Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, USA.Follow
Mark C. Preul, Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow

Document Type

Article

Abstract

Background We assessed a new robotic visualization platform with novel user-control features and compared its performance to the previous model of operative microscope. Methods In 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. Results The 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. Conclusion Improvements 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.

Publication Date

10-4-2018

Publication Title

Cureus

ISSN

2168-8184

Volume

10

Issue

7

First Page

e3072

PubMed ID

30280067

Digital Object Identifier (DOI)

10.7759/cureus.3072

Recommended Citation

Belykh, Evgenii G.; Zhao, Xiaochun; Cavallo, Claudio; Bohl, Michael A.; Yagmurlu, Kaan; Aklinski, Joseph L.; Byvaltsev, Vadim A.; Sanai, Nader; Spetzler, Robert F.; Lawton, Michael T.; Nakaji, Peter; and Preul, Mark C., "Laboratory Evaluation of a Robotic Operative Microscope - Visualization Platform for Neurosurgery" (2018). Neurosurgery. 1314.
https://scholar.barrowneuro.org/neurosurgery/1314