Business Standard

BRAIN SURGERY IN 3D COMING SOON TO THE OPERATING THEATRE

New ‘video microscope­s’ offer astounding images, helping surgeons perform and collaborat­e on delicate brain and spine operation,

- writes Denise Grady

One blue surgical dr ape at a time, the patient disappeare­d, until all that showed was a triangle of her shaved scalp. “Ten seconds of quiet in the room, please,” said David J Langer, the chairman of neurosurge­ry at Len ox Hill Hospital in Manhattan, part of North well Health. Silencef ell, until he said, “OK, I’ll take the scissors.”

His patient, Anita Roy, 66, had impaired blood flow to the left side of her brain, and L anger was about to perform bypass surgery ons lender, delicate art erie store store the circulatio­n and prevent a stroke.

The operating room was dark, and everyone was wearing 3- D glasses. Len ox Hill is the first hospital in the United States to buy a device known as a video microscope, which turns neurosurge­ry into a ni mme rs ive and sometimes dizzying expedition into the human brain.

Enlarged on a 55-inch monitor, the stubble on Roy’ s shaved scalp spiked up like re bar. The scissors and scalpel seemed big as hockey sticks, and popped out of the screen so vivid ly that observers felt an urge to duck. “This is like landing on the moon,” said a neurosurge­on who was visiting to watch and learn.

The equipment produces magnified, high-resolution, three-dimensiona­l digital images of surgical sites, and lets everyone in the room see exactly what the surgeon is seeing. The video microscope has a unique ability to capture “the brilliance and the beauty of then euro surgical anatomy ,” Langer said.

He and other surgeons who have tested it predict it will change the way many brain and spine operations are performed and taught .“The first time I used it, It old students that this gives them an understand­ing of why I went into neurosurge­ry in the first place ,” L anger said.

But there is more to it than just the gee whiz, I max factor. The shared viewing makes 3- D surgery an ideal teaching tool. In addition, Lange rand other doctors say the device is smaller and much less cumbersome than standard surgical microscope sand provides better light.

It can easily be moved and angled to show bits of anatomy that surgeons would otherwise have to twist and crane their necks to see. Two surgeons on opposite sides of the table can work together easily. Standard surgical micro scopes are enormous and require a complicate­d draping process to ensure sterility. Not so with the new video microscope, whichis covered with just a sleeve that L anger said can be slipped on like a condom.

Neurosurge­ry can take many hours, which surgeons operating with magnifying lo up es or microscope­s often spend looking down, their necks bent. As the clock ticks, discomfort become spain, and over the years chronic injury to the neck and back can bea career-en der for some surgeons. The new device lets them operate while looking straight ahead at the 3- D screen, using the image to guide their hands.

“I don’ t think there’ s any doubt that it’ s going to be valuable ,” L anger said. But, he added ,“In the eyes of someone who’ s more conservati­ve and who’ s not as willing to try new things, they may not get over the hump and be willing to do it .”

The device at Len ox Hill is called the Orbeye, made by Somed— a joint venture of Olympus and Sony— and marketed by Olympus. L anger has received consulting fees from the company.

A number of other medical centre sin the United States have also been testing the Orbeye. Charles L Branch, chief of neurosurge­ry at Wake Forest Baptist Medical Center in Winston-Salem, NC, said his first patient with it was a red bell pepper.

“I cut a hole and plucked seeds out of the center ,” he said .“I wanted to make sure you could seed own a tubular opening. It worked really well .” He quickly moved onto humans, and has used the equipment in about 20 spine surgeries, all minimal ly invasive and performed through a tube.

“The very first case, I almost felt like I was getting car sick ,” he said. But it was a fleeting sensation, and he adapted quickly.

“It’s really cool,” Branch said. “It’ s like being in the I max. It lets not only the surgeon but everybody else in the room see what’ s going on. Instead of having to lean up against the microscope, and strain my neck or back, I can stand comfortabl­y, look at the big screen in front of me and work with my hands .”

He described the camera as “a Coke can on a stick over my shoulder,” easy to move, adjust and angle into positions not possible with a microscope.

There are 10 neurosurge­ons in his department, Branch said .“Everyone that’ s used it has seen some potential benefit, but not everyone has decided they want to use it in every case.”

He said that the company had len tan Orb eye to his hospital for surgeons to try out, and that he hoped the hospital would buy“a handful” of the devices, more than one because so much surgery is done there. Branch said he had no financial ties to the company .“I don’ t think it’ s a gimmick ,” he said .“I believe it will be widely adopted fairly quickly.”

Mark Miller, a spokesman for Olympus, said the Orb eye’ s pricing would be similar to that of standard surgical micro scopes, which range from $200,000 to $1 million. The system that Len ox Hill bought cost about $400,000, L anger said. Other companies are also trying to enter the market .“I think we’ ll see three or four competitiv­e products pop up ,” Branch said .“That will make the technology less expensive .”

Bob S Carter, chief of neurosurge­ry at the Massachuse­tts General Hospital, said using the Orb eye was like having “Superman eyes ,” but added that his hospital was also evaluating other devices and had not yet decided which to buy. The technology, he said, is “the way of the future .”

Roy, are tired administra­tive assistant who lives in the Bronx, first noticed troubling symptoms in 2015: episodes of weakness in her right hand, and trouble speaking. Test sat a local hospital ruled out a stroke. But the occasional episodes continued, and in July 2017, while recovering from heart surgery at Len ox Hill, she had a seizure.

Her operation, on December 15, wasthe first bypass L anger performed with Orb eye, though he and his colleagues had used it for other operations. This type of bypass is one of the most difficult ne uro surgical operations, and requires stitching together arteries that are only a mil li met re or so in diameter. Colleagues say Lang eris one of the few surgeons in the world with the skill and experience to perform it well.

THE EQUIPMENT PRODUCES MAGNIFIED, HIGHRESOLU­TION, THREEDIMEN­SIONAL DIGITAL IMAGES OF SURGICAL SITES

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