Comparing Heads-Up versus Binocular Microscope Visualization Systems in Anterior and Posterior Segment Surgeries: A Retrospective Study

Abstract

Background: Three-dimensional (3D) visualization systems, also known as heads-up systems, are now available for eye surgery and as with every new device there is need for a specific evaluation. Objectives: The aim of this study was to compare the efficiency, surgical comfort, and safety of a 3D visualization system to a standard binocular microscope (BM) in routine ophthalmologic procedures. Method: After a 4-week training period, a 3D visualization system (Ngenuity, Alcon ®) available in one of the Robert Debré Hospital Ophthalmology Departments' operating rooms was compared to a standard BM (OPMI LUMIRA 700, Zeiss ®), in the process of a call for new device evaluation. From December 2017 to March 2018, 5 surgeons and their respective residents were asked to fill in a questionnaire for all procedures. Before the surgery, the surgeon recorded: (i) the type of surgery (cataract [PK], retinal detachment [RD], epiretinal membrane peeling [ERM], macular hole, vitreous haemorrhage [VH]), (ii) the type of visualization system chosen (3D or BM), and (iii) the estimated surgical risk (low, intermediate, or high grade). At the end of the procedure, the primary surgeon recorded

Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial

“…In our study, mean surgical duration with 3D DAVS was comparable to CAM. This result is supported by works of Coppola et al in 2017, Romano et al in 2018, Kumar et al in 2018, Palacois et al in 2019, Babu et al in 2020 and Berquet et al [ 4 10 11 13 17 22 ] Few studies have reported longer surgical duration but this can be attributed to learning curve of the surgeon. [ 12 ]…”

“…[ 25 ] Similar results leading to the superior surgeon's ergonomics have also been reported by many other workers. [ 4 5 8 9 10 11 12 19 20 21 22 25 18 ] 3D DAVS has also been described to perform surgery in patients with disabling musculoskeletal deformities (e.g., Kyphosis) when operating on a CAM is quite challenging. [ 16 ]…”

“…Various studies have been done in the past to assess the feasibility of performing vitreoretinal surgeries on 3D DAVS and have reported excellent outcomes, minimal complications, comparable surgical duration, and lower endoillumination. [ 10 11 12 13 14 15 16 17 18 19 20 21 22 ]…”

Three-Dimensional Heads-up Cataract Surgery Using Femtosecond Laser: Efficiency, Efficacy, Safety, and Medical Education—A Randomized Clinical Trial

“…[2][3][4][5] Moreover, 3D imaging allows observers to see exactly what the surgeon sees during the surgery, improving effectiveness in teaching and learning. 4,6,7 Since first developed in 2009, 8 heads-up surgery has gained increasing popularity in ophthalmic surgery, including Descemet membrane endothelial keratoplasty (DMEK), 9,10 cataract surgery, [11][12][13][14] and vitreoretinal surgery. 4,[15][16][17][18][19] Current reports on heads-up surgery mainly focus on its use in vitreoretinal disease because of its advantage of a lower endoillumination level and higher depth of field.…”

Comparison of Ngenuity and Traditional Microscope in Vitreoretinal Surgeries from Surgeon’s Perspective

“…This difference in the preference may be due to the image latency period that had a more de nite effect in the anterior procedures. This preference between the steps might change over the learning curve and many studies emphasize that surgeons felt more comfortable with Ngenuity in both anterior and posterior procedures after 3 or 4 surgeries which was considered to a short period [7,8].…”