First-in-Man Clinical Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery

2018 ◽  
Vol 16 (6) ◽  
pp. 717-725 ◽  
Author(s):  
Alexander A Khalessi ◽  
Ralph Rahme ◽  
Robert C Rennert ◽  
Pia Borgas ◽  
Jeffrey A Steinberg ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Arteriovenous Malformations ◽  
Foramen Magnum ◽  
Depth Of Field ◽  
Neutral Position ◽  
Surgical Experience ◽  
High Definition ◽  
Cavernous Malformations ◽  
3 Dimensional ◽  
Low Profile

ABSTRACT BACKGROUND During its development and preclinical assessment, a novel, 3-dimensional (3D), high-definition (4K-HD) exoscope system was formerly shown to provide an immersive surgical experience, while maintaining a portable, low-profile design. OBJECTIVE To assess the clinical applicability of this 3D 4K-HD exoscope via first-in-man surgical use. METHODS The operative workflow, functionality, and visual haptics of the 3D 4K-HD exoscope were assessed in a variety of microneurosurgical cases at 2 US centers. RESULTS Nineteen microneurosurgical procedures in 18 patients were performed exclusively using the 3D 4K-HD exoscope. Pathologies treated included 4 aneurysms, 3 cavernous malformations (1 with intraoperative electrocorticography), 2 arteriovenous malformations, 1 foramen magnum meningioma, 1 convexity meningioma, 1 glioma, 1 occipital cyst, 1 chiari malformation, 1 carotid endarterectomy, 1 subdural hematoma, 1 anterior cervical discectomy and fusion, and 2 lumbar laminectomies. All patients experienced good surgical and clinical outcomes. Similar to preclinical assessments, the 3D 4K-HD exoscope provided an immersive 3D surgical experience for the primary surgeon, assistants, and trainees. The small exoscope frame, large depth of field, and hand/foot pedal controls improved exoscope mobility, decreased need to re-focus, and provided unobstructed operative corridors. Flexible positioning of the camera allows the surgeon's posture to be kept in a neutral position with uncompromised viewing angles. CONCLUSION The first-in-man clinical experience with the 3D 4K-HD exoscope confirms its excellent optics and ergonomics for the entire operative team, with high workflow adaptability for a variety of microneurosurgical cases. Expanded clinical use of the 3D 4K-HD exoscope is justified.

Initial Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery

2017 ◽  
Vol 14 (4) ◽  
pp. 395-401 ◽  
Author(s):  
Jayson Sack ◽  
Jeffrey A Steinberg ◽  
Robert C Rennert ◽  
Dustin Hatefi ◽  
Jeffrey S Pannell ◽  
...  
Keyword(s):  
Neutral Position ◽  
The Novel ◽  
Operating Microscope ◽  
High Definition ◽  
Team Members ◽  
3 Dimensional ◽  
Primary Operator ◽  
Low Profile ◽  
Standard Operating ◽  
Operative Microscope

Abstract BACKGROUND The operative microscope and endoscope have significantly advanced modern neurosurgery. These devices are nonetheless limited by high costs and suboptimal optics, ergonomics, and maneuverability. A recently developed extracorporeal telescope (“exoscope”) operative system combines characteristics from both the operative microscope and endoscope and provides an affordable, portable, high-definition operative experience. Widespread use of exoscopes in neurosurgery has previously been limited by a lack of stereopsis with 2-dimensional(2-D) monitors. OBJECTIVE To assess the surgical potential of a novel, 3-D, high-definition (4K-HD) exoscope system. METHODS Assess dissection time and visualization of critical structures in a series of human cadaveric cranial neurosurgical approaches with the 3-D 4K-HD exoscope as compared to a standard operating microscope. RESULTS Dissection times and visualization of critical structures was comparable with the 3-D 4K-HD exoscope and a standard operating microscope. The low-profile exoscope nonetheless allowed for larger operative corridors, enhanced instrument maneuverability, and less obstruction in passing instrumentation. The large monitor also resulted in an immersive surgical experience, and gave multiple team members the same high-quality view as the primary operator. Finally, the exoscope possessed a more ergonomically favorable setup as compared to the traditional microscope, allowing the surgeon to be in a neutral position despite the operative angle. CONCLUSION The novel 3-D 4K-HD exoscope system possesses favorable optics, ergonomics, and maneuverability as compared to the traditional operating microscope, with the exoscope's shared surgical view possessing obvious educational and workflow advantages. Further clinical trials are justified to validate this initial cadaveric experience.

Application of High-Definition Fiber Tractography in the Management of Supratentorial Cavernous Malformations

Neurosurgery ◽  
2014 ◽  
Vol 74 (6) ◽  
pp. 668-681 ◽  
Author(s):  
Kumar Abhinav ◽  
Sudhir Pathak ◽  
R. Mark Richardson ◽  
Johnathan Engh ◽  
Paul Gardner ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Spatial Relationship ◽  
Fiber Tractography ◽  
High Definition ◽  
Cavernous Malformations ◽  
3 Dimensional ◽  
Corticospinal Tracts ◽  
Complete Disruption ◽  
Relationship Of ◽  
The Relationship

ABSTRACT BACKGROUND: High-definition fiber tractography (HDFT), an advanced white matter (WM) imaging technique, was evaluated in the management of supratentorial cavernous malformations. OBJECTIVE: To investigate the relationship of cavernous malformations to the relevant perilesional WM tracts with HDFT and to characterize associated changes first qualitatively and then quantitatively with our novel imaging measure, quantitative anisotropy (QA). METHODS: Imaging analysis was carried out by researchers blinded to the clinical details. Contralateral WM tracts were used for comparison. Mean QA values were obtained for whole WM tracts. Qualitatively affected superior longitudinal fasciculus/arcuate fibers and corticospinal tracts were further analyzed with the use of mean QA values for the perilesional segments. RESULTS: Of 10 patients, HDFT assisted with the decision-making process and the offer of surgical resection in 2 patients, lesion approach and removal in 7 patients, and conservative management in 1 patient. Of 17 analyzed WM tracts, HDFT demonstrated partial disruption in 2 tracts, complete disruption in 2 tracts, a combination of displacement and partial disruption in 1 tract, displacement only in 7 tracts, and no change in 5 tracts. Qualitative changes correlated with clinical symptoms. Mean QA values for the whole WM tracts were similar, with the exception of 1 case demonstrating complete disruption of 2 WM tracts. QA-based perilesional segment analysis was consistent with qualitative data in 5 assessed WM tracts. CONCLUSION: HDFT illustrated the precise spatial relationship of cavernous malformations to multiple WM tracts in a 3-dimensional fashion, optimizing surgical planning, and demonstrated associated disruption and/or displacement, with both occurring perilesionally. These changes were supported by our quantitative marker, which needs further validation.

Lessons Learned Using a High-Definition 3-Dimensional Exoscope for Spinal Surgery

2018 ◽  
Vol 16 (5) ◽  
pp. 619-625 ◽  
Author(s):  
Kevin Kwan ◽  
Julia R Schneider ◽  
Victor Du ◽  
Lukas Falting ◽  
John A Boockvar ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Clinical Effectiveness ◽  
Lessons Learned ◽  
Depth Of Field ◽  
Surgical Approaches ◽  
Quantitative Methodology ◽  
High Definition ◽  
3D Vision ◽  
Team Members ◽  
3 Dimensional

Abstract BACKGROUND The operative microscope has significantly advanced modern neurosurgical spine surgery but continues to be limited by high costs, suboptimal optics, poor ergonomics, and difficulties with maneuverability. We believe the novel 4K high-definition (4K-HD) 3-dimensional (3D) exoscope (EX), may improve the surgical corridor through advancements in illumination, ergonomics, magnification, and depth of field and has the potential to be utilized in neurosurgical education and training. OBJECTIVE To evaluate the surgical potential of a novel 3D EX system in spinal surgery. METHODS Retrospective analysis over 6 mo of all patients who have undergone spinal surgery at Northwell Health using the 3D EX. Nuances of surgical theater positioning, advantages/disadvantages of the EX and clinical sequelae of the patients were analyzed. RESULTS All 10 patients who underwent spinal surgery utilizing the EX experienced excellent surgical and clinical outcomes without complications. The low-profile EX allowed for excellent operative corridors and instrument maneuverability. The large monitor also resulted in an immersive surgical experience, and gave team members the same 3D vision as the operator. CONCLUSION This study demonstrates the feasibility of utilizing the 3D 4K-HD EX system and highlights potential technical assets of this novel technology in regard to optics, ergonomics, and maneuverability. Further clinical research is needed to examine the clinical effectiveness of the EX system for different surgical approaches through quantitative methodology.

Correlative transmission and high-resolution scanning electron microscopic studies on pituitary cells

1990 ◽  
Vol 48 (3) ◽  
pp. 20-21
Author(s):  
S. Tai
Keyword(s):  
Cell Types ◽  
Depth Of Field ◽  
Secretory Cells ◽  
Specific Cell ◽  
Pituitary Cells ◽  
Electron Microscopic ◽  
3 Dimensional ◽  
Microscopic Studies ◽  
Structure And Activity ◽  
Intracellular Structure

Extensive cytological and histological research, correlated with physiological experimental analysis, have been done on the anterior pituitaries of many different vertebrates which have provided the knowledge to create the concept that specific cell types synthesize, store and release their specific hormones. These hormones are stored in or associated with granules. Nevertheless, there are still many doubts - that need further studies, specially on the ultrastructure and physiology of these endocrine cells during the process of synthesis, transport and secretion, whereas some new methods may provide the information about the intracellular structure and activity in detail.In the present work, ultrastructural study of the hormone-secretory cells of chicken pituitaries have been done by using TEM as well as HR-SEM, to correlate the informations obtained from 2-dimensional TEM micrography with the 3-dimensional SEM topographic images, which have a continous surface with larger depth of field that - offers the adventage to interpretate some intracellular structures which were not possible to see using TEM.

First-in-Human Clinical Experience Using High Definition Exoscope with Intraoperative ICG for Clip Reconstruction of Unruptured Large Pediatric Aneurysm

2021 ◽  
Author(s):  
Arvin R. Wali ◽  
Keiko M. Kang ◽  
Robert Rennert ◽  
David Santiago-Dieppa ◽  
Alexander A. Khalessi ◽  
...  
Keyword(s):  
Clinical Experience ◽  
High Definition ◽  
Pediatric Aneurysm

scholarly journals Initial Clinical Experience with a New Low-Profile Thoracic Stent-Graft Prosthesis

2020 ◽  
Author(s):  
Hazem El Beyrouti ◽  
Nancy Halloum ◽  
Daniel Dohle ◽  
Christian Friedrich Vahl ◽  
Bernhard Dorweiler
Keyword(s):  
Clinical Experience ◽  
Stent Graft ◽  
Low Profile ◽  
Thoracic Stent Graft ◽  
Initial Clinical Experience

scholarly journals Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic

2021 ◽  
pp. 1-3
Author(s):  
M Ally ◽  
P Kullar ◽  
G Mochloulis ◽  
A Vijendren
Keyword(s):  
Residual Disease ◽  
Elective Surgery ◽  
Three Dimensional ◽  
Depth Of Field ◽  
High Definition ◽  
Microscopic Surgery ◽  
Lateral Skull Base ◽  
Mastoid Surgery ◽  
And Training

Abstract Objective Microscopic surgery is currently considered the ‘gold standard’ for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic. Method Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively. Results Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training. Conclusion The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.

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