surgical microscope
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2021 ◽  
Vol 8 ◽  
Author(s):  
Christian Marzi ◽  
Tom Prinzen ◽  
Julia Haag ◽  
Thomas Klenzner ◽  
Franziska Mathis-Ullrich

Robotic systems for surgery of the inner ear must enable highly precise movement in relation to the patient. To allow for a suitable collaboration between surgeon and robot, these systems should not interrupt the surgical workflow and integrate well in existing processes. As the surgical microscope is a standard tool, present in almost every microsurgical intervention and due to it being in close proximity to the situs, it is predestined to be extended by assistive robotic systems. For instance, a microscope-mounted laser for ablation. As both, patient and microscope are subject to movements during surgery, a well-integrated robotic system must be able to comply with these movements. To solve the problem of on-line registration of an assistance system to the situs, the standard of care often utilizes marker-based technologies, which require markers being rigidly attached to the patient. This not only requires time for preparation but also increases invasiveness of the procedure and the line of sight of the tracking system may not be obstructed. This work aims at utilizing the existing imaging system for detection of relative movements between the surgical microscope and the patient. The resulting data allows for maintaining registration. Hereby, no artificial markers or landmarks are considered but an approach for feature-based tracking with respect to the surgical environment in otology is presented. The images for tracking are obtained by a two-dimensional RGB stream of a surgical microscope. Due to the bony structure of the surgical site, the recorded cochleostomy scene moves nearly rigidly. The goal of the tracking algorithm is to estimate motion only from the given image stream. After preprocessing, features are detected in two subsequent images and their affine transformation is computed by a random sample consensus (RANSAC) algorithm. The proposed method can provide movement feedback with up to 93.2 μm precision without the need for any additional hardware in the operating room or attachment of fiducials to the situs. In long term tracking, an accumulative error occurs.


2021 ◽  
Vol 10 (22) ◽  
pp. 5375
Author(s):  
Jiro Akimoto ◽  
Shinjiro Fukami ◽  
Megumi Ichikawa ◽  
Kenta Nagai ◽  
Michihiro Kohno

Objective: The surgical eradication of malignant glioma cells is theoretically impossible. Therefore, reducing the number of remaining tumor cells around the brain–tumor interface (BTI) is crucial for achieving satisfactory clinical results. The usefulness of fluorescence–guided resection for the treatment of malignant glioma was recently reported, but the detection of infiltrating tumor cells in the BTI using a surgical microscope is not realistic. Therefore, we have developed an intraoperative rapid fluorescence cytology system, and exploratorily evaluated its clinical feasibility for the management of malignant glioma. Materials and methods: A total of 25 selected patients with malignant glioma (newly diagnosed: 17; recurrent: 8) underwent surgical resection under photodiagnosis using photosensitizer Talaporfin sodium and a semiconductor laser. Intraoperatively, a crush smear preparation was made from a tiny amount of tumor tissue, and the fluorescence emitted upon 620/660 nm excitation was evaluated rapidly using a compact fluorescence microscope in the operating theater. Results: Fluorescence intensities of tumor tissues measured using a surgical microscope correlated with the tumor cell densities of tissues evaluated by measuring the red fluorescence emitted from the cytoplasm of tumor cells using a fluorescence microscope. A “weak fluorescence” indicated a reduction in the tumor cell density, whereas “no fluorescence” did not indicate the complete eradication of the tumor cells, but indicated that few tumor cells were emitting fluorescence. Conclusion: The rapid intraoperative detection of fluorescence from glioma cells using a compact fluorescence microscope was probably useful to evaluate the presence of tumor cells in the resection cavity walls, and could provide surgical implications for the more complete resection of malignant gliomas.


Author(s):  
So Yoon Kwon ◽  
Ki-Cheol Yoon ◽  
Kwang Gi Kim

Abstract Inside the brain tumor, the blood vessels are intricately composed, and the tumors and blood vessels are similar in color. Therefore, when observing tumors and blood vessels with the naked eye or a surgical microscope, it is difficult to distinguish between tumors and blood vessels. Fluorescence staining with indocyanine green (ICG) is performed to distinguish between brain tumors and blood vessels using a surgical microscope. However, when observing the blood circulation state of a tumor or blood vessel through a surgical microscope, light reflection occurs from the camera. In the process of observing the state of the blood vessel, due to the occurrence of light reflection, an obstruction phenomenon in which the observation field is blocked by the blood vessel of the object to be observed occurs. Therefore, it is difficult to diagnose the vascular condition. In this experiment, the 780nm light-emitting diode (LED) was irradiated to the ICG phantom, and then, when the fluorescence expression image was observed, the polarizing filter such as circular polarized light (CPL) filter and linear polarized light (LPL) filter were inserted into the camera and the reflected light was reduced. Therefore, it is possible to reduce the reflected light from the fluorescence expression image by using a polarizing filter, and it is expected to be applicable to surgery and diagnostic fields of cancer such as surgery.


Author(s):  
J Chainey ◽  
B Zheng ◽  
M Kim ◽  
A Elomaa ◽  
R Bednarik ◽  
...  

Background: Gaze behavior differences between expert and novice surgeons have been established in previous studies mainly from the general surgery field.Limited information is available about surgeon’s visual attention during microsurgery procedures where surgical microscope is used. Methods: 4 experts and 3 novices performed 37 independent sutures under the surgical microscope.Eye movements of surgeons and scene video of the surgical performance were recorded.Total suturing time and subtask times were compared between level of expertise.We defined three discrete surgical actions and examined eye gaze (fixation) directly related to each of these actions.Fixation duration (measured by total,pre-action,and post-action duration) were compared between expert and novice, over 3 subtasks (piercing, exiting and cutting) and between pre- and post-action phases. Results: Expert surgeons completed the suture with shorter total time than novices.On average,expert displayed longer fixation time than novice.Experts also maintained their visual engagement constantly over the 3 level of subtask in comparison to novices who required a longer fixation time for the challenging subtask (piercing).Experts use longer pre- than post-action fixation, and this pattern is distributed over all three subtasks.This gaze engagement strategy was not shown in novices. Conclusions: The action-related fixation can be used to evaluate microsurgeons’ level of expertise and in surgical education for gaze training.


2021 ◽  
Vol 7 (2) ◽  
pp. 464-467
Author(s):  
Eric L. Wisotzky ◽  
Florian C. Uecker ◽  
Jean-Claude Rosenthal ◽  
Philipp Arens ◽  
Armin Schneider

Abstract We present a stereo-multispectral microscope equipped with an additional illumination unit allowing further narrow-band illumination in the spectral range of 400n.m up to 800nm. The combination of the normal microscope illumination with the multispectral light unit allows different illumination modalities to be realized, which enables intraoperative spectral tissue analysis with direct visualization. Two illumination methods were tested in two cholesteatoma surgeries. In addition, two cholesteatom samples were illuminated and analyzed ex vivo. Cholesteatoma showed :fluorescent characteristics in our ex vivo analysis. This behavior could be used intraoperatively using a combination of white light and strong near-UV to blue illumination to highlight cholesteatoma tissue in the microscopic image. Thus, the visual differentiability of different tissue types can be improved and the clinical decision-making process can be accelerated.


2021 ◽  
Author(s):  
Ki-Cheol Yoon ◽  
Kwang Gi Kim ◽  
Seung Hoon Lee

Abstract The advantage of handheld type surgical microscope is that the size of the probe is small and light, and the working distance(o to 30 cm) and field of view (306°) can be adjusted. Also, a short working distance will minimize the loss of light source energy. However, the currently developed handheld type surgical microscope is still large, heavy, and uses relatively high energy (600 mW). Also, it is not suitable for portable use. To address the aforementioned problems, this study aimed to develop a pen-type surgical fluorescence microscope that is compact, portable, and has an adjustable beam angle and working distance. The pen-type probe consists of a laser diode, CMOS camera, light source brightness control device, filter, and power switch. The IR-cut filter inside the CMOS camera was removed to facilitate transmission of the fluorescence emission wavelength. In addition, a long-pass filter was attached to the camera so that the external light source was blocked and only the fluorescence emission wavelength was allowed to pass through. The pen-type probe was manufactured using 3D printing, and the captured image was designed to be observed through an external monitor. The performance of the pen-type probe was tested through a large animal experiment. Indocyanine green (2.5mg/kg) was injected into a pig's vein. Fluorescence emission of 805-830 nm was achieved by irradiating an external light source (785 nm and 4 mW/cm2), and liver-uptake occurred after 2.4 minutes.


Author(s):  
Jiro Akimoto ◽  
shinjiro Fukami ◽  
Megumi Ichikawa ◽  
Kenta nagai ◽  
Michihiro Kohno

Objective: Surgical eradication of malignant glioma cells is theoretically impossible. Therefore, reducing the number of remaining tumor cells around the brain-tumor interface (BTI) is crucial for achieving satisfactory clinical results. The usefulness of fluorescence-guided resection for the treatment of malignant glioma was recently reported, but the detection of infiltrating tumor cells in the BTI using a surgical microscope is not realistic. Therefore, we developed an intraoperative rapid fluorescence cytology system, and evaluated its clinical feasibility for the management of malignant glioma. Materials and methods: Twenty-five selected patients with malignant glioma (newly diagnosed: 17; recurrent: 8) underwent surgical resection under photodiagnosis using photosensitizer Talaporfin sodium and a semiconductor laser. Intraoperatively, a crush smear preparation was made from a tiny amount of tumor tissue, and the fluorescence emitted upon 620/660 nm excitation was evaluated rapidly using a compact fluorescence microscope in the operating theater. Results: Fluorescence intensities of tumor tissues measured using a surgical microscope correlated with the tumor cell densities of tissues evaluated by measuring the red fluorescence emitted from the cytoplasm of tumor cells using a fluorescence microscope. A “weak fluorescence” indicated a reduction in the tumor cell density, whereas “no fluorescence” did not indicate the complete eradication of the tumor cells, but indicated that few tumor cells were emitting fluorescence.Conclusion: The rapid intraoperative detection of fluorescence from glioma cells using a compact fluorescence microscope was a useful to evaluate the presence of tumor cells in the resection cavity walls, and provides surgical implications for the more complete resection of malignant gliomas.


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