Illumination in Spinal Surgery Depending on Different Approaches and Light Sources

Near-Field LED Illumination Strategies for Tonsillectomy and Adenoid Surgery

Objective: Perform a pilot feasibility study to demonstrate viability, quality, and safety advantages of light-emitting diode (LED) illumination when performing tonsillectomy. Study Design: Prospective cohort. Setting: Children's Hospital and Community Multispecialty Hospital. Methods: We tested a commercially available LED light, held in position with a minimally modified mouth gag, for off-label use in a "cavernous wound." We assessed surgeons', residents', and nurses' perceptions of function, safety, as well as preferences compared to headlights. Results: The light was used in 30 cases. Noted advantages over traditional lighting methods included superior brightness, stability and consistency of illumination, and the ability for others to assist more quickly. The inability to adjust brightness and/or the angle of light was an observed disadvantage. A small oral cavity or large tonsillar pillars creating a shadow required the temporary addition of a headlight. However, LED light use was not discontinued. Surgeons and residents reported a preference for not wearing a headlight, and nurses expressed concerns about headlight cleanliness. Conclusion: LED lighting technology demonstrated utility for teaching surgeons, residents, and nurses, and was perceived as safe. Additional specifications may make the light applicable to a wider variety of cases and could potentially mitigate headlight use during procedures of the oral cavity and oropharynx.Level of Evidence: 4.

A virtual reality simulation of a novel way to illuminate the surgical field - A feasibility study on the use of automated lighting systems in the operating theatre

Introduction

Surgical lighting systems have to be re-adjusted manually during surgery by the medical personnel. While some authors suggest that interaction with a surgical lighting system in the operating room might be a distractor, others support the idea that manual interaction with the surgical lighting system is a hygiene problem as pathogens might be present on the handle. In any case, it seems desirable to develop a novel approach to surgical lighting that minimizes the need for manual interaction during a surgical procedure.

Methodes

We investigated the effect of manual interaction with a classical surgical lighting system and simulated a proposed novel design of a surgical lighting system in a virtual reality environment with respect to performance accuracy as well as cognitive load (measured by electroencephalographical recordings).

Results

We found that manual interaction with the surgical lights has no effect on the quality of performance, yet for the price of a higher mental effort, possibly leading to faster fatigue of the medical personnel in the long run.

Discussion

Our proposed novel surgical lighting system negates the need for manual interaction and leads to a performance quality comparable to the classical lighting system, yet with less mental load for the surgical personnel.

5-Aminolevulinic acid-enhanced fluorescence-guided treatment of high-grade glioma using angled endoscopic blue light visualization: technical case series with preliminary follow-up

OBJECTIVE

5-Aminolevulinic acid (5-ALA)-enhanced fluorescence-guided resection of high-grade glioma (HGG) using microscopic blue light visualization offers the ability to improve extent of resection (EOR); however, few descriptions of HGG resection performed using endoscopic blue light visualization are currently available. In this report, the authors sought to describe their surgical experience and patient outcomes of 5-ALA-enhanced fluorescence-guided resection of HGG using primary or adjunctive endoscopic blue light visualization.

METHODS

The authors performed a retrospective review of prospectively collected data from 30 consecutive patients who underwent 5-ALA-enhanced fluorescence-guided biopsy or resection of newly diagnosed HGG was performed. Patient demographic data, tumor characteristics, surgical technique, EOR, tumor fluorescence patterns, and progression-free survival were recorded.

RESULTS

In total, 30 newly diagnosed HGG patients were included for analysis. The endoscope was utilized for direct 5-ALA-guided port-based biopsy (n = 9), microscopic to endoscopic (M2E; n = 18) resection, or exoscopic to endoscopic (E2E; n = 3) resection. All endoscopic biopsies of fluorescent tissue were diagnostic. 5-ALA-enhanced tumor fluorescence was visible in all glioblastoma cases, but only in 50% of anaplastic astrocytoma cases and no anaplastic oligodendroglioma cases. Gross-total resection (GTR) was achieved in 10 patients in whom complete resection was considered safe, with 11 patients undergoing subtotal resection. In all cases, endoscopic fluorescence was more avid than microscopic fluorescence. The endoscope offered the ability to diagnose and resect additional tumor not visualized by the microscope in 83.3% (n = 10/12) of glioblastoma cases, driven by angled lenses and increased fluorescence facilitated by light source delivery within the cavity. Mean volumetric EOR was 90.7% in all resection patients and 98.8% in patients undergoing planned GTR. No complications were attributable to 5-ALA or blue light endoscopy.

CONCLUSIONS

The blue light endoscope is a viable primary or adjunctive visualization platform for optimization of 5-ALA-enhanced HGG fluorescence. Implementation of the blue light endoscope to guide resection of HGG glioma is feasible and ergonomically favorable, with a potential advantage of enabling increased detection of tumor fluorescence in deep surgical cavities compared to the microscope.

Size matters - From the working channel to the wavelength of light: Optimizing visualization in endoscopic spine surgery

BACKGROUND

Minimally invasive surgery bases many of its benefits on decreasing tissue disruption. Endoscopic spine surgery has continued to push the boundaries to accomplish successful clinical outcomes through the evolution of the endoscope and working channel. As the indications for endoscopic spine surgery increase, a more profound discussion of cannula size selection for endoscopic spine surgery is required. The intimate relationship between the working channel, the endoscope and how these choices affect workflow and visualization are paramount to maximize outcomes.

METHODS

The authors review the nuances of the endoscopic approaches to the various regions of the spine as it relates to the selection of the working channel. The advantages and limitations of various endoscopic working channels were analyzed as to how they address anatomic regional considerations as well as ultimate goals of surgery.

RESULTS

In addition to anatomic regional differences and the goals of the surgery other key elements in endoscopic working channel selection included the amount of tissue disruption, regional risk to the neural elements, impact on visualization, optical physics, and the implications for surgical maneuverability/dexterity.

CONCLUSION

Understanding the role and use of the endoscope-working channel combination with its effects on visualization is essential for any surgeon aspiring to perform safe and efficient full endoscopic spine surgery.