Abstract
Minimally-invasive microsurgery has resulted in improved outcomes for patients. However, operating through a microscope limits depth perception and fixes the visual perspective, which result in a steep learning curve to achieve microsurgical proficiency. We introduce a surgical imaging system employing four-dimensional (live volumetric imaging through time) microscope-integrated optical coherence tomography (4D MIOCT) capable of imaging at up to 10 volumes per second to visualize human microsurgery. A custom stereoscopic heads-up display provides real-time interactive volumetric feedback to the surgeon. We report that 4D MIOCT enhanced suturing accuracy and control of instrument positioning in mock surgical trials involving 17 ophthalmic surgeons. Additionally, 4D MIOCT imaging was performed in 48 human eye surgeries and was demonstrated to successfully visualize the pathology of interest in concordance with preoperative diagnosis in 93% of retinal surgeries and the surgical site of interest in 100% of anterior segment surgeries. In vivo 4D MIOCT imaging revealed sub-surface pathologic structures and instrument-induced lesions that were invisible through the operating microscope during standard surgical maneuvers. In select cases, 4D MIOCT guidance was necessary to resolve such lesions and prevent post-operative complications. Our novel surgical visualization platform achieves surgeon-interactive 4D visualization of live surgery which could expand the surgeon’s capabilities.
Highlights
Image in real-time[10,11,12,13]
We report on the translation of a microscope-integrated Optical coherence tomography (OCT) (MIOCT) system that achieves, to our knowledge, the first four-dimensional (4D: volumetric imaging through time) real-time presentation of live human microsurgery to the surgeon
We report that 4D MIOCT improved the performance of select depth-based maneuvers in mock surgical trials compared to maneuver guidance with the operating microscope alone
Summary
Image in real-time[10,11,12,13]. Recent work on near-infrared (NIR) optical imaging demonstrated potential for guiding open-body and laparoscopic surgeries[14]. During image-guided general surgery, wall-mounted displays and more recently developed head-mounted displays can relay important feedback to the surgeon[14,15] These techniques are not generally applicable in microsurgery where the surgeon’s visual field is constrained by the operating microscope oculars. Others employed a stereo camera to record and project the view through the operating microscope onto a stereo external monitor[19] All these previous intraoperative feedback mechanisms were limited to visualization of 2D images, and more recent techniques for manipulation and visualization of volumetric data[20] are not currently compatible with live human microsurgery. During imaging of 48 human eye surgeries, we demonstrates 4D MIOCT identification of previously unrecognized tissue micro-architectural alterations during common surgical maneuvers, and 4D MIOCT-guided resolution of lesions that were invisible under conventional surgical illumination
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