Heads-up 3D eye surgery: Safety outcomes and technological review after 2 years of day-to-day use

Background: 3D heads-up visualization systems are aimed to improve the surgical experience by providing high-resolution imaging. Objective of our study is to analyze, over a long-time span, the grade of satisfaction and safety of day-to-day 3D surgery compared to standard surgery and to investigate the technical distinctiveness between the heads-up systems currently in use. Methods: In this retrospective observational case series. we reviewed all surgical records of our ophthalmology-dedicated operatory rooms since the arrival of 3D heads-up viewing system, in November 2017. In particular, we compared the procedural complications of 3D-equipped operatory room (3DR) with the standard microscope operatory room (2DR). Moreover, a satisfaction questionnaire was administered to those surgeons shifting on both rooms to test their preferences on seven specific parameters (comfort, visibility, image quality, depth perception, simplicity of use, maneuverability and teaching potential). Results: 5483 eye surgeries were considered. 2777 (50.6%) were performed in 3DR and 2706 (49.3%) in 2DR. Procedural complication rate was comparable in 3DR and 2DR, also when considering different subtypes of surgery. Twelve surgeons (100% of our surgery team) participated in our satisfaction survey, expressing highest satisfaction score for 3D when applied in retina surgery. For cataract surgery, 3D scored best in all the parameters except for facility in use and depth of field perception. Conclusion: Long-term day-to-day use of 3D heads-up visualization systems showed its safety and its outstanding teaching potential in all ophthalmic surgical subtypes, with higher surgeons confidence for retina and cataract surgery.

Early results in applicating 3D laparoscopic surgery for colon cancer at Hue Central Hospital

Tóm tắt Mục tiêu: Đánh giá kết quả sớm điều trị ung thư đại tràng bằng phẫu thuật nội soi 3D. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả bao gồm 38 người bệnh (NB) được chẩn đoán ung thư đại tràng, được điều trị bằng phẫu thuật nội soi 3D tại bệnh viện Trung ương Huế từ tháng 1/2018 đến tháng 6/2019. Kết quả: Độ tuổi trung bình: 59,61 ± 14,37. Tỷ lệ nam / nữ là 2,5/1. Đau bụng là lý do vào viện thường gặp nhất (60,5%). Triệu chứng đau bụng là 86,8%, CEA tăng trước mổ (38,9%). Tỷ lệ phát hiện khối u trên CTscaner là 81,6%. Khối u trên 5 cm là 26,3%. Nội soi đại tràng thể sùi chiếm tỷ lệ cao nhất (71,1%). Khối u đại tràng phải có tỷ lệ là 52,6%. Khối u giai đoạn T3 có tỷ lệ 68,4%. Thời gian mổ trung bình là 144,5 ± 56,4 phút, thấp nhất là 90 phút, cao nhất là 210 phút. Không gặp tai biến trong mổ. Không có trường hợp nào chuyển sang mổ mở. Kích thước đường mổ trung bình là 5,08 ± 1,65cm, nhiễm trùng vết mổ là 7,9%. Thời gian nằm viện trung bình là 9,1 ± 2,4 ngày. 100% ung thư biểu mô tuyến. Đau bụng sau mổ 1 tháng có 18 người bệnh (47,3%), sau mổ 6 tháng có 5 người bệnh (20,8%). Rối loạn tiêu hóa sau mổ 1 tháng có 9 người bệnh (23,7%), sau mổ 3 tháng có 3 người bệnh (10,3 %), sau mổ 6 tháng có 2 người bệnh (8,3%). Sau mổ 3 tháng tỷ lệ tăng CEA có 2 người bệnh (6,9%), sau mổ 6 tháng có 3 người bệnh (12,5%). Nội soi đại tràng cho kết quả viêm phù nề miệng nối sau 3 tháng có 6 người bệnh (20,7%), sau 6 tháng có 6 người bệnh (25%). Không thấy thương tổn trên CT scan bụng có thuốc sau 3 và 6 tháng. Kết luận: Phẫu thuật nội soi 3D trong điều trị ung thư đại tràng là phương pháp phẫu thuật an toàn, hiệu quả. Abstract Objective: Evaluating the early results of application of 3D laparoscopic surgery for rectal cancer. Material and methods: The descriptive research enrolled 38 patients were diagnosed colon cancer, treated by 3D laparoscopic surgery at Hue Central Hospital from January 2018 to June 2019. Result: The age average was 59.61 ± 14.37. The male / female rate was 2.5/1. Abdominal pain is the most common reason for hospitalization 60.5%. Abdominal pain accounted for 86.8%, pre-operative CEA increased was in 38.9%. The detection on CTscaner was 81.6%. The size of tumors above 5 cm 26.3%. Type of fold convergence appearance is highest rate on endoscopic feature 71.1%. Right colon tumor was the highest 52.6%. T3 accounts for the highest rate of 68.4%. The average time of surgery is 144.5 ± 56.4 minutes, shorted is 90 minutes, longest is 210 minutes. No accident was observed during surgery. There are no cases converted to open surgery. The average size of surgical incision was 5.08 ± 1.65cm, surgical site infection accounts for 7.9%. The average hospital length stay is 9.1 ± 2.4 days. Adenocarcinoma 100%. Postoperative abdominal pain in 1 month were 18 patients (47,3%), in 6 months were 5 patients (20.8%). Postoperative gastrointestinal disorders in 1 month were observed in 9 patients (23.7%), in 3 months were 3 patients (10.3%), 6 months were 2 patients (8.3%). The rate of CEA increased in 3 months after operation were 2 patients (6.9%), after 6 months were 3 patients (12.5%). The inflammation anastomosis by colonoscopy check after 3 months were 6 patients (20.7%), after 6 months were 6 patients (25%). No findings of lesions on CT scan after 3 and 6 months. Conclusion: Laparoscopic 3D surgery is safe and effective treatment for colon cancers. Key words: Laparoscopic 3D surgery, colon cancer.

Heads-Up 3D Surgery under Low Light Intensity Conditions: New High-Sensitivity HD Camera for Ophthalmological Microscopes

Purpose. To determine the feasibility of performing intraocular surgeries in a heads-up position with low illuminance conditions by observing a display of the surgical field created by a three-dimensional imaging (3D) system. Methods. Seventy-four eyes of 56 patients underwent cataract surgery (72 eyes) with the heads-up 3D surgery system; 60 eyes with cataract surgery alone, 7 eyes with combined cataract and glaucoma microdevice implant surgery, 5 eyes with combined cataract and vitrectomy surgery, and two eyes with vitrectomy surgery alone were studied. The illuminance from the surgical microscope was set to be dimmer (Leica M822F40 main light 2%; otto-flex 6%) than the usual setting to minimize the discomfort and glare for the patient. The surgeries were performed under topical anesthesia. The luminance of the images observed through the eyepieces of the operating microscope and the image of a 3D system created by a high-sensitivity sensor Exmor R 3CMOS HD camera (Sony MCC-1000MD) were measured. Results. All surgeries were completed without any complications under the low illumination conditions. The surgical field on the display monitor was created by a 3D system using a high-sensitivity sensor camera and was observed in a heads-up position. The patients did not report any intolerable discomfort or glare during the surgery. Cataract surgeries were performed with a good view of the surgical field under the extremely low illumination from the surgical microscope. The high-sensitivity sensors and electronic amplifications of the image signals made the surgical field brighter and allowed the surgeon to perform the surgery confidently and safely. Conclusions. Heads-up, 3D-assisted intraocular surgeries can be performed safely and efficiently with low illuminance of the surgical field. This trial is registered with UMIN000037838.

Rapid Ethnography – The Study of Behavior, Communication, and Context in Cosmetic Surgery Consultations and the Design of a New Medical Device

Ethnographic research methods are increasingly popular within the general field of Human Factors, usability, user experience and design. Through a case story from the development and design of a medical device called 3D Surgery – a decision aid to be used in surgeon-patient consultations for cosmetic breast surgery – the presentation exemplifies the value and efficiency of the use of rapid ethnography used as stand-alone method and in combination with other methods. The case study describes an iterative approach encompassing continuous adjustment of method repertoire as well as continuous adjustment of use of analytical tools through which insights into the specific context of use are built. The case study further illustrates how the pre-surgery consultation and decision making process of the patient can be analyzed, and how the knowledge acquired can be transferred into design criteria for the 3D Surgery System.