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Moon JY, Seddon I, Sokol JT, Zeng R, Ludwig CA, Wu F, Rahimy E, Houston SK, Miller JB. Comparison of Ergonomics in Vitreoretinal Surgery With Heads-up Visualization Versus the Standard Operating Microscope as Measured by a Wearable Device. Ophthalmic Surg Lasers Imaging Retina 2024:1-8. [PMID: 39037360 DOI: 10.3928/23258160-20240508-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Three-dimensional heads-up display (HUD) systems have emerged as an alternative to standard operating microscope (SOM) in the operating room. The goal of this study was to quantitatively measure vitreoretinal surgeon posture across visualization methods. METHODS Ergonomic data was collected from 64 cases at two tertiary eye care centers. Surgeons wore an Upright Go 2TM posture training device while operating either using the NGENUITY 3D heads-up display visualization system or the SOM. RESULTS Total percentage of time with upright posture as primary surgeon was significantly higher in surgeries performed using HUD (median 100%, interquartile range [IQR], 85.1% to 100.0%) as compared to surgeries performed using the SOM (median 60.0%, IQR 1.8% to 98.8%) (P = 0.001, Wilcoxon rank-sum test). Percent time with upright posture was significantly higher in surgeries performed using HUD for two of the three surgeons when assessed independently across systems. Results remained significant when accounting for length of surgery (P < 0.001, multiple linear regression). CONCLUSIONS Ergonomic positioning was improved for surgeons operating using HUD. Given the high prevalence of back and neck pain among vitreoretinal surgeons, increased use of HUD systems may limit musculoskeletal pain and long-term disability from poor ergonomics. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Talcott KE, Knapp AN, Amine R, Matar K, Srivastava SK, Rachitskaya A, Sharma S, Singh RP, Yuan A, Reese JL, Ehlers JP. Comparing Three-Dimensional Digitally Enabled Intraoperative OCT With Conventional Microscope-Integrated OCT in Vitreoretinal Surgery: A Post Hoc Analysis of the Discover Study. Ophthalmic Surg Lasers Imaging Retina 2024:1-8. [PMID: 38648428 DOI: 10.3928/23258160-20240206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVE This study compared the surgeon experience between conventional microscope-integrated intraoperative optical coherence tomography (iOCT) and digitally enabled microscope-integrated iOCT in vitreoretinal surgery. PATIENTS AND METHODS This is a post hoc case-control analysis of the DISCOVER study. Conventional microscope-integrated iOCT (Rescan 700, Zeiss) was compared with digitally enabled iOCT (Artevo 800, Zeiss). Compared variables included surgical field-based visualization (ie, ocular heads-up display in the conventional group; three-dimensional screen-based visualization in the digital iOCT group) and non-surgical field-based visualization (ie, review on the external two-dimensional monitor). RESULTS A total of 200 patients were included. Surgical field-based visualization of iOCT was significantly higher in the digitally enabled group (P < 0.0001). Required endoillumination level was significantly lower in the digital iOCT group (P < 0.0001). Surgeons reported "significant" back discomfort and headache more frequently when using conventional iOCT (P = 0.003 and P = 0.001, respectively). CONCLUSIONS Digitally enabled iOCT resulted in greater surgical visualization efficiency, appeared to require a lower illumination level, and may provide advantages for ergonomic-related discomfort. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Demetz M, Abramovic A, Krigers A, Bauer M, Lener S, Pinggera D, Kerschbaumer J, Hartmann S, Fritsch H, Thomé C, Freyschlag CF. Cadaveric study of ergonomics and performance using a robotic exoscope with a head-mounted display in spine surgery. J Robot Surg 2024; 18:6. [PMID: 38198072 PMCID: PMC10781796 DOI: 10.1007/s11701-023-01777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024]
Abstract
The conventional microscope has the disadvantage of a potentially unergonomic posture for the surgeon, which can affect performance. Monitor-based exoscopes could provide a more ergonomic posture, as already shown in pre-clinical studies. The aim of this study was to test the usability and comfort of a novel head-mounted display (HMD)-based exoscope on spinal surgical approaches in a simulated OR setting. A total of 21 neurosurgeons naïve to the device were participated in this prospective trial. After a standardized training session with the device, participants were asked to perform a single-level thoracolumbar decompression surgery on human cadavers using the exoscope. Subsequently, all participants completed a comfort and safety questionnaire. For the objective evaluation of the performance, all interventions were videotaped and analyzed. Twelve men and nine women with a mean age of 34 (range: 24-57) were participating in the study. Average time for decompression was 15 min (IqR 9.6; 24.2); three participants (14%) terminated the procedure prematurely. In these dropouts, a significantly higher incidence of back/neck pain (p = 0.002 for back, p = 0.046 for neck pain) as well as an increased frequency of HMD readjustments (p = 0.045) and decreased depth perception (p = 0.03) were documented. Overall, the surgeons' satisfaction with the exoscope was 84% (IqR 75; 100). Using a standardized, pre-interventional training, it is possible for exoscope-naïve surgeons to perform sufficient spinal decompression using the HMD-based exoscope with a high satisfaction. However, inaccurate HMD setup prior to the start of the procedure may lead to discomfort and unsatisfactory results.
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Affiliation(s)
- Matthias Demetz
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Aleksandrs Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Marlies Bauer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Helga Fritsch
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Sarikonda A, Leibold A, Ali DM, Thalheimer S, Heller J, Prasad S, Sharan A, Harrop J, Vaccaro AR, Sivaganesan A. What is the Marginal Intraoperative Cost of Using an Exoscope or Operative Microscope for Anterior Cervical Discectomy and Fusion? A Time-Driven Activity-Based Cost Analysis. World Neurosurg 2024; 181:e3-e10. [PMID: 37992992 DOI: 10.1016/j.wneu.2023.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Our primary objective was to compare the intraoperative costs of 3 different surgical visualization techniques for anterior cervical discectomy and fusion (ACDF). Specifically, we used time-driven activity-based costing (TDABC) methodology to compare costs between ACDFs performed with operative microscopes (OM-ACDF), exoscopes (EX-ACDF), and loupes (loupes-ACDF). METHODS Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. We identified all instances of loupes-ACDF (n = 882), EX-ACDF (n = 26), and OM-ACDF (n = 52) performed at our institution. We performed multivariable linear regression analyses to compare costs between these modalities, accounting for patient-specific factors as well as number of levels fused, surgeon, and hospital site. RESULTS The average total intraoperative costs per loupes-ACDF, EX-ACDF, and OM-ACDF cases were $7081 +/- $2,942, $7951 +/- $3,488, and $6557 +/- $954, respectively. Regression analysis revealed no difference in intraoperative cost between loupes-ACDF and EX-ACDF (P = 0.717), loupes-ACDF and OM-ACDF (0.954), or OM-ACDF and EX-ACDF (0.217). On a more granular level, however, EX-ACDF was associated with increased cost of consumables, including drapes, compared to both OM-ACDF (β-coefficient: $369 +/- $121, P = 0.002) and loupes-ACDF (β-coefficient: $284 +/- $86, P = 0.001). CONCLUSIONS Although hospitals may be aware of the purchasing fees associated with microscopes and exoscopes, there is no clear documentation of how these technologies affect intraoperative cost. We demonstrate a novel use of TDABC for this purpose.
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Affiliation(s)
- Advith Sarikonda
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
| | - Adam Leibold
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Daniyal Mansoor Ali
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Sara Thalheimer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Joshua Heller
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Srinivas Prasad
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | | | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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Abramovic A, Demetz M, Krigers A, Bauer M, Lener S, Pinggera D, Kerschbaumer J, Hartmann S, Fritsch H, Thomé C, Freyschlag CF. Surgeon's comfort: The ergonomics of a robotic exoscope using a head-mounted display. BRAIN AND SPINE 2022; 2:100855. [PMID: 36248127 PMCID: PMC9560643 DOI: 10.1016/j.bas.2021.100855] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/26/2023]
Abstract
Introduction Conventional microscopes have certain limitations in terms of posture and ergonomics. Monitor-based exoscopes could solve this problem and thereby lead to less work-related sick leave for surgeons. Research question The aim of this study was to assess the ergonomics, usability, and neurosurgeon's comfort of a novel three-dimensional head-mounted display-based exoscope in a standardized setting. Material & Methods 34 neurosurgeons participated in a workshop on the exoscope, which features a head-mounted display and a head gesture-triggered control panel. After completion of a custom-made 10-step microsurgical exercise, image quality and comfort were assessed using a questionnaire. The participants' posture during the exercise was analyzed using a video motion analysis software. Results 34 participants (median neurosurgical experience: 6 years) were included. The median time to complete the exercise was 12 min [IqR 9.4, 15.0]. Younger participants (p = 0.005) and those with video game experience (p = 0.03) had a significantly steeper learning curve. The median overall satisfaction was at 80% in general and 82% for image quality. The median upper body as well as the median head coronal displacement from the neutral axis were 0°. Participants with less microsurgical experience showed less head/body displacement during the exercise (p = 0.01). Discussion and conclusion Using the microsurgical training tool, we were able to depict a steep learning curve with a sufficient learnability of the most relevant commands. The exoscope excelled in usability, image quality as well as in ergonomic and favorable posture and could thus become an alternative to conventional microscopes due to the potentially elevated surgeons' comfort. Overall, the participants were satisfied with the exoscope usability (80%) and image quality (82%). The custom-made microsurgical exercise tool is an efficient tool for assessment of the participant's performance with the head-mounted display-based exoscope. Younger participants with video games experience showed a steeper learning curve for the performance of the microsurgical training tool. After performing theexercise, 88% of the participants felt safe to use the HMD-based exoscope in the OR.
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Rani D, Kumar A, Chandra P, Chawla R, Hasan N, Agarwal D. Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial. Indian J Ophthalmol 2021; 69:320-325. [PMID: 33463583 PMCID: PMC7933851 DOI: 10.4103/ijo.ijo_1720_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM). Methods: 68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months. Results: 68 eyes of 68 patients with median age 52.5 (range 18–68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary (P > 0.99) and recurrent (P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group. Conclusion: 3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.
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Affiliation(s)
- Deeksha Rani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nasiq Hasan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Posarelli C, Sartini F, Casini G, Passani A, Toro MD, Vella G, Figus M. What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review. J Clin Med 2020; 9:jcm9061682. [PMID: 32498222 PMCID: PMC7356858 DOI: 10.3390/jcm9061682] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Optical coherence tomography (OCT) has recently been introduced in the operating theatre. The aim of this review is to present the actual role of microscope-integrated optical coherence tomography (MI-OCT) in ophthalmology. Method: A total of 314 studies were identified, following a literature search adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. After full-text evaluation, 81 studies discussing MI-OCT applications in ophthalmology were included. Results: At present, three microscope-integrated optical coherence tomography systems are commercially available. MI-OCT can help anterior and posterior segment surgeons in the decision-making process, providing direct visualization of anatomic planes before and after surgical manoeuvres, assisting in complex cases, and detecting or confirming intraoperative complications. Applications range from corneal transplant to macular surgery, including cataract surgery, glaucoma surgery, paediatric examination, proliferative diabetic retinopathy surgery, and retinal detachment surgery. Conclusion: The use of MI-OCT in ophthalmic surgery is becoming increasingly prevalent and has been applied in almost all procedures. However, there are still limitations to be overcome and the technology involved remains difficult to access and use.
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Affiliation(s)
- Chiara Posarelli
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56126 Pisa, Italy; (C.P.); (G.C.); (A.P.); (G.V.); (M.F.)
| | - Francesco Sartini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56126 Pisa, Italy; (C.P.); (G.C.); (A.P.); (G.V.); (M.F.)
- Correspondence: ; Tel.: +39-050-997-675
| | - Giamberto Casini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56126 Pisa, Italy; (C.P.); (G.C.); (A.P.); (G.V.); (M.F.)
| | - Andrea Passani
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56126 Pisa, Italy; (C.P.); (G.C.); (A.P.); (G.V.); (M.F.)
| | - Mario Damiano Toro
- Department of General Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland;
- Faculty of Medical Sciences, Collegium Medicum Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
| | - Giovanna Vella
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56126 Pisa, Italy; (C.P.); (G.C.); (A.P.); (G.V.); (M.F.)
| | - Michele Figus
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56126 Pisa, Italy; (C.P.); (G.C.); (A.P.); (G.V.); (M.F.)
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