The visualization of the surgical field in tubular assisted spine surgery: Is there a difference between HD-endoscopy and microscopy?

2017 ◽  
Vol 158 ◽  
pp. 5-11 ◽  
Author(s):  
Benedikt W. Burkhardt ◽  
M. Wilmes ◽  
Salman Sharif ◽  
Joachim M. Oertel
Keyword(s):  
Spine Surgery ◽  
Surgical Field

scholarly journals Hand-Held Stereovision System for Image Updating in Open Spine Surgery

2020 ◽  
Vol 19 (4) ◽  
pp. 461-470
Author(s):  
Xiaoyao Fan ◽  
Maxwell S Durtschi ◽  
Chen Li ◽  
Linton T Evans ◽  
Songbai Ji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spine Surgery ◽  
Surgical Navigation ◽  
Image Data ◽  
Ground Truth ◽  
Acquisition Time ◽  
Fiducial Markers ◽  
Image Pair ◽  
3 Dimensional ◽  
Surgical Field

Abstract BACKGROUND Image guidance in open spinal surgery is compromised by changes in spinal alignment between preoperative images and surgical positioning. We evaluated registration of stereo-views of the surgical field to compensate for vertebral alignment changes. OBJECTIVE To assess accuracy and efficiency of an optically tracked hand-held stereovision (HHS) system to acquire images of the exposed spine during surgery. METHODS Standard midline posterior approach exposed L1 to L6 in 6 cadaver porcine spines. Fiducial markers were placed on each vertebra as “ground truth” locations. Spines were positioned supine with accentuated lordosis, and preoperative computed tomography (pCT) was acquired. Spines were re-positioned in a neutral prone posture, and locations of fiducials were acquired with a tracked stylus. Intraoperative stereovision (iSV) images were acquired and 3-dimensional (3D) surfaces of the exposed spine were reconstructed. HHS accuracy was assessed in terms of distances between reconstructed fiducial marker locations and their tracked counterparts. Level-wise registrations aligned pCT with iSV to account for changes in spine posture. Accuracy of updated computed tomography (uCT) was assessed using fiducial markers and other landmarks. RESULTS Acquisition time for each image pair was <1 s. Mean reconstruction time was <1 s for each image pair using batch processing, and mean accuracy was 1.2 ± 0.6 mm across 6 cases. Mean errors of uCT were 3.1 ± 0.7 and 2.0 ± 0.5 mm on the dorsal and ventral sides, respectively. CONCLUSION Results suggest that a portable HHS system offers potential to acquire accurate image data from the surgical field to facilitate surgical navigation during open spine surgery.

scholarly journals Spine Surgery Supported by Augmented Reality

2020 ◽  
Vol 10 (2_suppl) ◽  
pp. 41S-55S
Author(s):  
Barbara Carl ◽  
Miriam Bopp ◽  
Benjamin Saß ◽  
Mirza Pojskic ◽  
Benjamin Voellger ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Spine Surgery ◽  
Low Dose ◽  
Automatic Registration ◽  
Surgical Workflow ◽  
Registration Error ◽  
Surgical Field ◽  
Low Dose Computed Tomography ◽  
Potential Tool ◽  
Case Based

Study Design: A prospective, case-based, observational study. Objectives: To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. Methods: In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. Results: AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably. Conclusions: Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.

scholarly journals Use of labetalol and glyceryl trinitrate for induced hypotension in spine surgery- A comparative study

2014 ◽  
Vol 22 (2) ◽  
pp. 48-53 ◽  
Author(s):  
Sabina Yeasmeen ◽  
Md Rafayet Ullah Siddique ◽  
Amirul Islam ◽  
AKM Aktaruzzaman ◽  
Debabrata Banik ◽  
...  
Keyword(s):  
Heart Rate ◽  
Blood Loss ◽  
Glyceryl Trinitrate ◽  
Spine Surgery ◽  
Study Groups ◽  
Reduce Blood Loss ◽  
Induced Hypotension ◽  
Surgical Field ◽  
Induction Of Anaesthesia

Background: Induced hypotension is used to reduce blood loss especially in those operations where even a small amount of blood can obscure the operative field such as spine surgery. Objectives: To compare the effect of labetalol with that of glyceryl trinitrate to reduce intraoperative blood loss by inducing elective hypotension without any tachycardia and to improve quality of surgical field during spine surgery. Method: A total number of thirty patients (ASA grade I & II) were selected randomly into two groups, fifteen in each group. Group-I received glyceryl tinitrate (1000?g) and Group-II received labetalol (5mg) intravenously 3 minutes before induction of anaesthesia. Heart rate, mean arterial pressure was observed in two study groups 15 minutes interval in intra-operative period and quality of surgical field was detected by 4 points VRS (Verbal rating scale) after completion of surgery by asking the surgeon. Results: Heart rate varied significantly in two study groups after induction of anaesthesia except baseline and pre induction (p< 0.05). Labetalol associated with improved quality of surgical field visualization than glyceryltrinitrate (p = 0.034). Conclusion: Our study concluded that labetalol is effective than glyceryltrinitrate to reduce blood loss in spine surgery. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18141 Journal of BSA, 2009; 22(2): 48-53

scholarly journals The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery

2021 ◽  
Vol 11 (1) ◽  
pp. 223
Author(s):  
Nicola Montemurro ◽  
Alba Scerrati ◽  
Luca Ricciardi ◽  
Gianluca Trevisi
Keyword(s):  
Spine Surgery ◽  
Surgical Complication ◽  
Safe Alternative ◽  
3D Vision ◽  
New Era ◽  
Clinical Series ◽  
Surgical Field ◽  
Meta Analyses ◽  
Tools And Techniques ◽  
Operative Microscope

Background: Exoscopes are a safe and effective alternative or adjunct to the existing binocular surgical microscope for brain tumor, skull base surgery, aneurysm clipping and both cervical and lumbar complex spine surgery that probably will open a new era in the field of new tools and techniques in neurosurgery. Methods: A Pubmed and Ovid EMBASE search was performed to identify papers that include surgical experiences with the exoscope in neurosurgery. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) were followed. Results: A total of 86 articles and 1711 cases were included and analyzed in this review. Among 86 papers included in this review 74 (86%) were published in the last 5 years. Out of 1711 surgical procedures, 1534 (89.6%) were performed in the operative room, whereas 177 (10.9%) were performed in the laboratory on cadavers. In more detail, 1251 (72.7%) were reported as brain surgeries, whereas 274 (16%) and 9 (0.5%) were reported as spine and peripheral nerve surgeries, respectively. Considering only the clinical series (40 studies and 1328 patients), the overall surgical complication rate was 2.6% during the use of the exoscope. These patients experienced complication profiles similar to those that underwent the same treatments with the OM. The overall switch incidence rate from exoscope to OM during surgery was 5.8%. Conclusions: The exoscope seems to be a safe alternative compared to an operative microscope for the most common brain and spinal procedures, with several advantages that have been reached, such as an easier simplicity of use and a better 3D vision and magnification of the surgical field. Moreover, it offers the opportunity of better interaction with other members of the surgical staff. All these points set the first step for subsequent and short-term changes in the field of neurosurgery and offer new educational possibilities for young neurosurgery and medical students.

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