Surgical Loupes Research Articles

Implication of surgical loupes on complications following thyroidectomy: a meta-analysis.

To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy. PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024. Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests. The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = - 0.87 [(- 1.58, - 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) = - 0.31 [(- 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) = - 0.34 [(- 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) = - 0.85 [(- 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group. Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes. 3a.

P41. Eye radiation dose comparison between surgical loupes, lead-lined glasses, and plastic face shield

P41. Eye radiation dose comparison between surgical loupes, lead-lined glasses, and plastic face shield

Systematic Review and Meta-Analysis of the Outcomes After Hepatic Artery Reconstruction in Pediatric Liver Transplantation Using a Microscope Versus Surgical Loupe

BackgroundTo review the impact of the operating microscope (OM) for reconstruction of the hepatic artery (HA) by comparing the outcomes with standard loupe reconstruction (SL) in pediatric liver transplantation (LT). MethodsStudies comparing the application of OM and SL for the reconstruction of the HA in primary pediatric LT were included from a systematic search of MEDLINE, Cochrane Library and EMBASE from inception to June 2022. Re-transplantation, dual grafts and auxiliary transplants were excluded. Primary outcome was the rate of HA thrombosis (HAT). Secondary outcomes were graft loss and mortality. ResultsThere were 1261 liver recipients from 9 included studies published until June 2022. There were 484 patients in the OM group and 777 patients in the SL group. HAT incidence with OM was significantly lower with OR = 0.18 (95% CI: 0.07-0.48). The 1-year graft survival was significantly better in the OM group with OR = 2.77 (95% CI: 1.13-6.80). 1-year overall mortality was also significantly lower with OM with OR = 0.39 (0.18-0.86). The use of OM did not significantly impact the incidence of HAT in the living donor liver transplant subgroup. Differences in time for hepatic HA reconstruction, total operating time and length of hospital stay did not reach statistical significance. ConclusionThe use of OM has reduced the risk of HAT, graft loss and mortality in pediatric liver transplantation. Adoption of microsurgical principles in general may have contributed to the improved outcomes with SL reconstruction of HA in pediatric LT.

Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study.

To document the Outcomes of AV fistula formation for dialysis patients using interrupted sutures. In this Cross-sectional study conducted at PNS Shifa Karachi, from June 2022 to June 2023, patients above 18 years of age, male or female, with ESRD/CKD were included. After clinical screening and ultrasound doppler, the distal most part of wrist was considered as a site for radio cephalic AVF. Operation was performed under surgical loupe with 4.5x magnification. Standard incision of about 4-5 cm oblique proximal to the wrist crease was given at the volar surface on the radial side of Distal forearm, extending till the lateral side up to the snuffbox. Subcutaneous tissue was incised and dissection was done to identify the cephalic vein and radial artery. Distal most end of the cephalic vein was ligated using vicryl 4-0 suture and cephalic vein dissected free from the underling tissue to mobilize it up to the radial artery. During the study N=35 patients who required AVF creation visited the department. The mean age of the study participants was 59.34±15.48. If thrill at the site of AVF and backflow at cut end of cephalic vein were present the surgeons were satisfied, higher satisfaction among the surgeon was achieved in the AVF created at brachiocephalic artery while the diameter of vessels didn't contribute in surgeon satisfaction. Presence of thrill at the site of AVF and backflow at cut end of cephalic vein have strong association with good prognosis of AVF.

A Wearable Fluorescence Imaging Device for Intraoperative Identification of Human Brain Tumors.

Malignant glioma (MG) is the most common type of primary malignant brain tumors. Surgical resection of MG remains the cornerstone of therapy and the extent of resection correlates with patient survival. A limiting factor for resection, however, is the difficulty in differentiating the tumor from normal tissue during surgery. Fluorescence imaging is an emerging technique for real-time intraoperative visualization of MGs and their boundaries. However, most clinical grade neurosurgical operative microscopes with fluorescence imaging ability are hampered by low adoption rates due to high cost, limited portability, limited operation flexibility, and lack of skilled professionals with technical knowledge. To overcome the limitations, we innovatively integrated miniaturized light sources, flippable filters, and a recording camera to the surgical eye loupes to generate a wearable fluorescence eye loupe (FLoupe) device for intraoperative imaging of fluorescent MGs. Two FLoupe prototypes were constructed for imaging of Fluorescein and 5-aminolevulinic acid (5-ALA), respectively. The wearable FLoupe devices were tested on tumor-simulating phantoms and patients with MGs. Comparable results were observed against the standard neurosurgical operative microscope (PENTERO® 900) with fluorescence kits. The affordable and wearable FLoupe devices enable visualization of both color and fluorescence images with the same quality as the large and expensive stationary operative microscopes. The wearable FLoupe device allows for a greater range of movement, less obstruction, and faster/easier operation. Thus, it reduces surgery time and is more easily adapted to the surgical environment than unwieldy neurosurgical operative microscopes. Clinical and Translational Impact Statement-The affordable and wearable fluorescence imaging device developed in this study enables neurosurgeons to observe brain tumors with the same clarity and greater flexibility compared to bulky and costly operative microscopes.

A Simple and Effective Technique for Torn Hernial Sac Occurred During Large Inguinal Hernia Repair or Orchiopexy: Incision

Tearing of hernial sac during giant inguinal hernia repair or orchiopexy presents a challenge to the pediatric surgeons, even in expert hands. We here describe a technique that is easy for performing high ligation in cases complicated with torn hernial sac. The steps of our incision technique is: Non-separated part was tightened with the help of forceps localized at the lateral aspects of teared sac. The incision to the sac was fashioned by scalpel No 15, while taking care to avoid injury to the underlying testicular vessels and vas deferens. Then, wound edges of the proximal hernia sac were moved forward by using fine tissue forceps and scalpel. The walls of proximal sac were totally grasped in one forceps and dissected gently from the remaining adhesions and cremasteric fibers up to the level of the internal ring. The mean age of the patients was 13.9±18.1 months (range 3 weeks-7 years). The diagnosis of the patients was inguinal hernia in 17 (63%) and undescended testis in 10 (37%). Seven (25,9%) of the patients had a large inguinal hernia sac. There were no intraoperative and postoperative complications. This is a safe and effective technique in patients complicated with torn hernial sac during herniotomy. It reduces the risk of further tearing of hernial sac. Short duration is another advantage. This technique can also be performed with using surgical loupe or microscope to care not to damage the vas and vessels.

Can the exoscope be a game-changer for cleft palate surgery?

Cleft palate surgery represents a challenge for cleft surgeons, due to functional implications of an adequate reconstruction of the palate in a narrow operative field [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . Surgical loupes remain the mostly used magnification system for soft palate repair all over the world, with some drawbacks: restricted magnification capacity, offering a poor ergonomic posture, and limited surgical staff involvement. Furthermore, it is estimated that about 83% of cleft surgeons suffer from work-related musculoskeletal disorders and palate surgery can be considered one of the most uncomfortable procedures [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . The introduction of the microscope [2] Sommerlad B.C. The use of the operating microscope for cleft palate repair and pharyngoplasty. Plast Reconstr Surg. 2003 Nov; 112: 1540-1541https://doi.org/10.1097/01.PRS.0000085598.26409 Crossref PubMed Scopus (0) Google Scholar for the video-assistance of cleft palate surgery offered stereoscopic vision with higher magnification capabilities, a better ergonomic position and, by connecting a monitor, a better involvement of the surgical staff. However, its use in pediatric transoral surgery presents some difficulties in terms of adaption and challenging setting: for these reasons, the microscope is widely used only for dissection of the muscular plane, limiting its advantages and increasing the surgical times with its setting and dismissal.

ENDODONTIC MANAGEMENT OF TWO ROOTED MANDIBULAR SECOND PREMOLAR WITH HYPERTAURODONTISM AND THREE CANALS

Mandibular second premolars have earned the status for having aberrant anatomy. The occurrence of two roots with hypertaurodontism in mandibular premolars is quite rare. The present case describes endodontic management of two rooted mandibular second premolar with hypertaurodontism and three canals with combined use of the SLF dental surgical loupe and CBCT aiding to locate the canal orifices and bifurcation of root.

(130) Marsupialization of the Bartholin Duct Cyst and Recanalization for Symptomatic Recurrent Bartholin Cysts

Abstract Introduction Bartholin glands (BGs) are located posteriorly on each side of the vaginal introitus. During sexual arousal, BGs release mucinous secretions into the vestibule at the 5:00 and 7:00 positions via a 2.5 cm Bartholin duct (BD). The BD may become obstructed from trauma, inflammation, infection, vestibular or vulvar surgery, or idiopathic factors. Despite BD obstruction, the glands may continue to produce mucinous secretion causing cystic dilation of the duct. Thus, a Bartholin duct cyst (BC) is formed and can result in pain during sexual arousal. Treatment strategies include sitz baths, hot compresses, aspiration, Word catheter placement, or BC marsupialization. Objective This chart review was performed to assess the safety and efficacy of a new technique for BD marsupialization in patients with symptomatic BC. Methods This is a chart review of patients with symptomatic BC who underwent BD marsupialization using a new technique. This new strategy involves marsupialization of the anterior wall of the BC, identification of the BD lumen on the posterior wall of the BC under surgical Loupes magnification and advancement of the BD lumen directly to the surface of the introitus at 5:00 and/or 7:00 locations. The BD neo-ostium was secured with interrupted 4.0 chromic sutures. Results 14 patients (mean age 28 ± 9 years) between 2015 - 2022 diagnosed with recurrent BC-induced pain during sexual arousal were treated by marsupialization of the BC and advancement of the BD directly to the mucosal surface of the introitus. Each patient averaged 3 prior BC treatments (range 0- 6). Symptoms included pain with sexual arousal or walking/sitting (100%) and an introitus mass interfering with penetration (50%). The mean BC size on ultrasound was 2.7 ± 1.6 cm x 2.4 ± 1.7 cm. All BD marsupialization surgeries were performed as outpatient procedures. Sexual arousal was encouraged early post-operatively and mucinous secretion documented by vestibular photography post-arousal. With an average follow-up of 14 months, 11/14 (79%) symptomatic BCs have resolved. Conclusions A new surgical strategy is described for patients with symptomatic BCs involving BD anastomosis directly to the introital mucosa at the 5:00 or 7:00 locations, resolution of BD obstruction, and excellent restoration of BG lubrication. Disclosure No

Augmented Reality Microsurgery: Proof of Concept for a Novel Approach to Microsurgical Field Visualization in Plastic Surgery.

Microsurgery is conducted on tiny anatomical structures such as blood vessels and nerves. Over the past few decades, little has changed in the way plastic surgeons visualize and interact with the microsurgical field. New advances in augmented reality (AR) technology present a novel method for microsurgical field visualization. Voice- and gesture-based commands can be used in real time to adjust the size and position of a digital screen. Surgical decision support and/or navigation may also be used. The authors assess the use of AR in microsurgery. The video feed from a Leica Microsystems OHX surgical microscope was streamed to a Microsoft HoloLens2 AR headset. A fellowship-trained microsurgeon and three plastic surgery residents then performed a series of four arterial anastomoses on a chicken thigh model using the AR headset, a surgical microscope, a video microscope (or "exoscope"), and surgical loupes. The AR headset provided an unhindered view of the microsurgical field and peripheral environment. The subjects remarked on the benefits of having the virtual screen track with head movements. The ability of participants to place the microsurgical field in a tailored comfortable, ergonomic position was also noted. Points of improvement were the low image quality compared with current monitors, image latency, and the lack of depth perception. AR is a useful tool that has the potential to improve microsurgical field visualization and the way surgeons interact with surgical monitors. Improvements in screen resolution, latency, and depth of field are needed.

Microfasciectomy in Dupuytren's disease: microsurgery in the evolution toward safer and more efficient fasciectomy and hand surgery.

In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren's contracture. The risk for complications is significant, certainly in recurrent disease and in the presence of abundant scar tissue. Meticulous surgical technique is mandatory. Microsurgery increases magnification from four times (with surgical loupes) up to 40 times. Using the microscope in Dupuytren's surgery, a technique named microfasciectomy is likely to increase both safety and efficiency by preventing instead of treating surgical complications. Increased experience with microsurgery will benefit Dupuytren's treatment and hand surgery in general.

179 Measuring Real Time Radiation Exposure to Spine-Focused Neurosurgeons

INTRODUCTION: C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. While a surgeon’s chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection. METHODS: This prospective cohort study includes 65 consecutive spine surgeries performed by a single spine-focused neurosurgeon over a 9-month period. Radiation exposure to the primary surgeon was measured through dosimeters worn over the lead apron, under the lead apron, on surgical loupes, and as a ring on the dominant hand. Differences were assessed with rigorous statistical testing and radiation exposure per surgical case was extrapolated. RESULTS: During the study, the measured radiation exposure over the apron, 176 mrem, was significantly greater than that under the apron, 8 mrem (p = .0020), demonstrating shielding’s protective effect. The surgeon’s dominant hand was exposed to 329 mrem while the eyes were exposed to 152.5 mrem of radiation. Compared to the surgeon’s protected abdominal area, the hands (p = .0002) and eyes (p=.0002) received significantly greater exposure. Calculated exposure per case was 2.8 mrem for the eyes and 5.1 mrem for the hands. It was determined that a spine-focused neurosurgeon operating 400 cases annually will incur a radiation exposure of 60,750 mrem to the hands and 33,900 mrem to the eyes over a 30-year career. CONCLUSIONS: Our study found that spine surgeons encounter significantly more radiation exposure to the eyes and the extremities compared to protected body regions. Lifetime exposure exceeds the annual limits set by the International Commission on Radiological Protection for the extremities (50,000 mrem/yr) and the eyes (15,000 mrem/yr), calling for increased awareness about the dangerous levels of radiation exposure that a spine surgeon incurs over one’s career.

Comparing Thyroidectomy Techniques, Surgical Loupe and Neuromonitoring Between ENT and Endocrine Surgeons-an Observational Study.

Thyroid surgery is performed by ENT head and neck (ENT-HNS), endocrine (ES) and general surgeons (GS). Each modality adopts different surgical techniques causing difference in outcome, operative time and postoperative complication. A retrospective chart review of thyroid surgeries performed by two ENT-HNS, three ES of a single tertiary center was conducted. We compared the use of neuromonitoring and surgical loupe and subsequent patient outcomes between surgeries performed by ENT-HNS versus ES, focusing on parathyroid gland identification, operative duration, vocal cord paralysis and length of hospital stay. A total of 167 patients underwent thyroid surgery. Surgical loupes were used in all the surgeries performed by ENT-HNS vs. 85% by the ES. Parathyroid glands were identified in all the surgeries performed by ENT-HNS versus 95% by ES. Neuromonitoring was used in all the surgeries performed by ENT-HNS, and none by the ES. Vocal cord paralysis developed in two patients of ES versus none in the ENT-HNS. Mean operative duration for total thyroidectomy in ENT-HN surgeries, 183.7min vs. 151min in the ES. The mean hospital stay of patients was 3.6 ± 1.6 days for ENT-HNS, and 5.45 ± 3 days for ES. Identification of parathyroid gland and recurrent laryngeal nerve by neuromonitoring and surgical loupes may increase operative time but decrease the rate of vocal cord paralysis and increases the chance of parathyroid gland identification.

First integrated camera and headlight for dental and surgical loupes

First integrated camera and headlight for dental and surgical loupes

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study.

Eighty patients with thyroid nodules who underwent thyroidectomy procedure were divided randomly into two comparable groups, group A subjected to thyroidectomy by using binocular magnification loupe, group B underwent conventional thyroidectomy without using magnification. Patients' demographics, operation time, and postoperative morbidities were recorded. All cases had preoperative and postoperative vocal cords assessment by video laryngoscopy. Pathology, laboratory, and radiology investigations were also conducted. Out of 80 patients, there were 58 females and 22 males. Benign thyroid pathology was found in 74 patients and malignant pathology in 6 patients. The mean operating time was 106min in group A compared to 138.5min in group B. The mean amount of intraoperative bleeding was 30ml in group A while 50ml in group B. There were no cases of the external branch of the superior laryngeal nerve in both groups; there was better identification in group A. There was only one patient who suffered from a temporary RLN injury in group A, while three cases of temporary and one case of permanent RLN injury were recorded in group B. Permanent hypoparathyroidism was diagnosed in only one patient in group B. The utilization of binocular surgical loupe magnification in thyroid surgery is considered a safe and effective maneuver that has the advantages of decreasing the overall operating time and significantly reducing postoperative complications.

A Prospective Cohort Study of Radiation Exposure to a Spine Surgeon's Exposed Body Parts During Utilization of Intraoperative Radiation-based Imaging.

Prospective cohort study. C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. Although a surgeon's chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection. In this study, we compare differences in intraoperative radiation exposure across the protected and unprotected regions of a surgeon's body. Sixty-five consecutive spine surgeries were performed by a single spine-focused neurosurgeon over 9 months. Radiation exposure to the primary surgeon was measured through dosimeters worn over the lead apron, under the lead apron, on surgical loupes, and as a ring on the dominant hand. Differences were assessed with rigorous statistical testing and radiation exposure per surgical case was extrapolated. During the study, the measured radiation exposure over the apron, 176 mrem, was significantly greater than that under the apron, 8 mrem (P = 0.0020), demonstrating a shielding protective effect. The surgeon's dominant hand was exposed to 329 mrem whereas the eyes were exposed to 152.5 mrem of radiation. Compared with the surgeon's protected abdominal area, the hands (P = 0.0002) and eyes (P = 0.0002) received significantly greater exposure. Calculated exposure per case was 2.8 mrem for the eyes and 5.1 mrem for the hands. It was determined that a spine-focused neurosurgeon operating 400 cases annually will incur a radiation exposure of 60,750 mrem to the hands and 33,900 mrem to the eyes over a 30-year career. Our study found that spine surgeons encounter significantly more radiation exposure to the eyes and the extremities compared with protected body regions. Lifetime exposure exceeds the annual limits set by the International Commission on Radiologic Protection for the extremities (50,000 mrem/y) and the eyes (15,000 mrem/y), calling for increased awareness about the dangerous levels of radiation exposure that a spine surgeon incurs over one's career.

A Multicenter Study Investigating the Surgeon Experience with a Robotic-Assisted Exoscope as Part of the Neurosurgical Armamentarium

Improvement of visualization tools in neurosurgery such as the exoscope has raised the question of how this technology compares to the conventional microscope for surgeon ergonomics, discomfort, and patient outcomes. Exoscopes have the advantage of greater optical zoom, resolution, and illumination at a lower light intensity. Heads-up display for both the primary surgeon and other assistants permits neutral positioning of the surgeons while placing the camera in more angled positions. In a survey sample, this study assesses the surgeon experience utilizing 3D exoscope in general neurosurgery cases. Data weere recorded by 8 surgeons at 5 separate hospitals utilizing a mobile phone application survey. Surgeons recorded information about case type, intraoperative clinical outcomes such as blood loss and extent of resection, whether fluorescence visualization was used, as well as surgeon pain when compared to matched cases using conventional tools. A total of 155 neurosurgical cases were recorded in this multisite study, including 72% cranial cases and 28% spinal cases. Of the cranial cases, 76% were brain tumor resections (31% of which were brain metastases). Surgeons reported significantly less neck (P < 0.0001) and back (P < 0.0001) pain in cases when using the robotic exoscope compared with the conventional microscope or surgical loupes. Surgeons did not convert to a microscope in any case. The exoscope provides excellent delineation of tissue with high resolution. Surgeon pain was markedly reduced with the robotic exoscope when compared with conventional technology, which may reduce work-related injury and fatigue, potentially leading to better patient outcomes.

First integrated camera and headlight for dental and surgical loupes.

First integrated camera and headlight for dental and surgical loupes.

A comparison of loupe-assisted and non-loupe-assisted subinguinal varicocelectomy.

Varicocele is a treatable aetiology of male infertility. Magnification with surgical loupe has been associated with improved outcome and reduced morbidity than the conventional technique without magnification. To compare the outcomes of two techniques of subinguinal varicocelectomy, with a surgical loupe and without. This was a prospective randomised hospital-based study. Forty-six patients were randomised to two arms - Group A: loupe-assisted subinguinal varicocelectomy (LASV) and Group B: open subinguinal varicocelectomy without Loupe (OSV). They all had their semen and hormonal parameters compared preoperatively and at 3 and 6 months postoperatively. Post-operative complications were also assessed. P < 0.05 was considered statistically significant. The mean age was 38.28 ± 4.55 years with a range of 27-46 years. The mean age in Group A was 37.35 ± 4.68 and 39.22 ± 4.33 years in Group B. There was an improvement in motility, sperm count and concentration in both the groups at 3 and 6 months (P < 0.05). However, there was no difference in these parameters on comparison of the two groups at 3 and 6 months (P > 0.05). Follicle-stimulating hormone decline was significant in the OSV group at 3 and 6 months, P = 0.010 and 0.021, respectively. There was no difference in other hormonal parameters both at 3 and 6 months (P > 0.05). The pregnancy rate in each arm of study was 4.3%. All complications occurred in Group B. Both techniques resulted in improvement in seminal fluid parameters. All complications occurred in the arm that had subinguinal varicocelectomy without loupe. Loupe-assisted subinguinal varicocelectomy is safe and effective.

Reliability of CBCT in working length determination for successful endodontic treatment- an in vitro study

Aim: To evaluate and compare the accuracy of working length determination using Radiovisiography, Cone Beam Computed Tomography and Actual working length of the tooth. Material and Methods: After the access cavity preparation in seventy- two extracted human single rooted teeth, the working length was measured, using Radiovisiography and Cone beam Computed Tomography and its accuracy was compared with the actual working length of the teeth using surgical loupes. Unpaired ‘t’ test was used to test the significance of difference observed in mean working length measurements. Results:. The difference in distribution of readings was found insignificant (p&lt;0.75) by Chi square analysis. The result showed that cone beam computed tomography working length had high percentage of accurate readings as compared to radiographic working length readings. The results also showed high Karl Pearson’s correlation coefficient between the actual working length, radiographic and CBCT working length. Conclusions: Cone beam computed tomography (CBCT) imaging is as accurate and valuable adjunct as the actual working length in determining working length. Clinical Significance: Considering the availability of CBCT and its wide implication in endodontics, there is a need to explore if CBCT can be used as a tool at par with the actual working length determination in endodontics.