Head‐up display assisted endoscopic lumbar discectomy—A technical note

Abstract

Background: Minimally invasive surgery is heavily dependent on indirect visualization and image guidance, often resulting in non-ergonomic postures. Minimally invasive surgeons are more likely to experience neck pain, shoulder pain, and fatigue compared to open surgeons. Spinal endoscopy is rapidly increasing in popularity among minimally invasive spine surgeons. A primary ergonomic issue is the position of the endoscope display, which is often not in line with the operative field or the surgeon's natural line of sight. Methods: Smart glasses providing a head-up display are used in a case of percutaneous endoscopic lumbar discectomy to bring the surgeon's line of sight into parallel with the operative field. Results: Bringing the surgeon's visual and motor axes into parallel resulted in a more comfortable and ergonomic operating position. Conclusions: Head-up displays may provide an elegant and relatively simple solution to the issue of inadequate ergonomics in minimally invasive surgery.

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“…Furthermore, it will enable surgeons to proceed with surgery without taking their attention away from the procedure, resulting in shorter operative times and reduced radiation exposure [67][68][69]. In the field of neurospine surgery, several attempts to use smart-glass displays as intraoperative neuromonitors [70], endoscopic monitors [71], display devices for fluoroscopy [68], and 3D navigation screens [67,69] have been reported. Moreover, with VR-HMD as a video viewing device, the 360 • operative images and surgeon view with action camera can provide residents and medical students with a sense of immersion and realism, allowing them to experience surgery in an educational way, rather than by just observing it [20,22].…”

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“…Kaneko et al and Lim et al examined the merits of using smart glasses during an ultrasound-guided procedure in their randomized control studies, and these investigators concluded that smart glasses improved ergonomic efficiency by reducing head movements. 4,6 In the field of neurospine surgery, several attempts to use smart glasses displays as an intraoperative neuromonitor, 8 endoscopic monitor, 9 or 3D navigation screen have been reported. Yoon et al investigated the feasibility of streaming navigation images onto smart glasses during pedicle screw placement.…”

“…2). 9 When using a wireless connection, surgeons can perform procedures more comfortably with full-body mobility.…”

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“…AR displays are heads-up displays (HUDs) that show the same information as spinal navigation computer screens, directly onto the surgeon’s AR headset. Dr. Urakov has been able to demonstrate this when he successfully reported on an endoscopic lumbar discectomy with the direct endoscopic images being displayed to the surgeon’s lenses [ 28 ]. With direct line of sight of navigation/imaging, surgeons can also apply this technology to more complex cases.…”