A High-Definition Exoscope System for Neurosurgery and Other Microsurgical Disciplines: Preliminary Report

Abstract

An 8-mm diameter rigid lens telescope with a focal distance of 20 cm was developed for open microsurgery. The telescope was attached to a 3-chip high-definition digital camera and then to a high-definition monitor. A pneumatic scope holder permitted repositioning. The optical quality of the device was compared with the operating microscope with a step wedge and 1-mm grid paper. Craniotomies and microsurgical dissections with the telescope system (high-definition exoscope system) were performed in a live pig model. The high-definition exoscope system provided image quality that rivaled the operating microscope even at high magnification. The system was easy to manipulate and comfortable during neurosurgical operations. The lack of stereopsis was a relative drawback of the system but was compensated for with repeated procedures. Overall, this prototype telescope-based system rivals the operating microscope optical quality and field of view. With further refinement, this system could have widespread application in many microsurgical disciplines.

Evaluation of a Video Telescopic Operating Microscope (VITOM) for Pediatric Surgery and Urology: A Preliminary Report

“…The most striking finding of the study was the consensus of all participants of the superb HD image quality and clear resolution of anatomic detail, which has been reported in previous studies in neurosurgery, otolaryngology, and gynecology. 9,[12][13][14] The VITOM imaging system lends itself well to neonatal and pediatric surgical cases by providing clear visualization of the operation to all operating room personnel, many of whom would typically not be able to see the small operative field because of limitations of space, lack of magnifying loupes, or both.…”

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

“…Previous studies in which the manual-holder exoscope was used have mentioned that the lack of binocular stereopsis is a significant limitation for approaching deep-seated cranial lesions, which is in part due to the limitations of the scope holder that require continuous repetitive manual movement to create a coaxial direct line-of-site, resulting in optimal visualization. 22,23 However, we found that the dynamic movement of the robotic arm within the surgical corridor, in both its axial and in particular the rotational planes, provided an important means to compensate for the inherent lack of binocular stereoscopic vision through motion and parallax. This is in keeping with the previous experience that we have described, suggesting that dynamic movement represents a critical compensation for 2D image generated by neuroendoscopic surgery.…”

“…In particular, Mamelak et al have described a high-definition exoscopic payload for use in cranial and spinal neurosurgery. 22,23 However, this particular exoscope is attached to a static holder that requires repeated manual repositioning to achieve each new viewing angle and is not specifically designed based on the performance of the other 4 components of the optical chain. The ROVOT-m, on the other hand, comprises an exoscopic (telescopic) payload that is coupled to an automated robotic arm, which dynamically repositions it through a global positioning navigation system using a computer-machine interface that creates a fully integrated system, wherein each component is designed to enhance the overall performance of the collective elements of the optical chain.…”

Optical requirements on magnification systems for intracranial video microsurgery

“…It has already been attempted to find alternative visualization methods. 8,19 CONCLUSION From an optical point of view, current operating microscopes seem to meet the requirements of neurosurgery in most aspects. However, ergonomically speaking, further developments are highly desirable.…”

“…7 The costs of the high-end technology are size and unhandiness of these devices. 8 The dimensions of the optical components and the necessity of their strict geometrical alignment are opposed to the manufacturers' endeavor of improving ergonomic aspects. The surgeon often has to operate under, ergonomically speaking, unfavorable, and hindering conditions, especially when the patient is positioned semisitting and the surgeon has to encompass the voluminous microscope while performing fine dissection in deep-seated locations.…”