Digitally Assisted Vitreoretinal Surgery using the NGENUITY 3-D System

Abstract

Purpose : Traditional microscopic surgery is close to reaching theoretical performance limitations. Optical microscopes are bulky and require inverters and laser filters, with difficulty in adapting OCT and other accessory imaging instruments and require bright light sources because the surgeon’s view is often split. We evaluated a digital surgical microscope, the NGENUITY system, and compared it to traditional vitreoretinal surgery using a modern ophthalmic microscope. The NGENUITY system permits Digitally Assisted Vitreoretinal Surgery (DAVS).

Methods : Four retinal surgeons and one anterior segment surgeon performed a total of 20 procedures using the NGENUITY 3D visualization system. Cases alternated with conventional optical microscopy to permit comparisons. The digital system involved a digital camera, with two high-definition, high refresh rate sensors, mounted onto the objective portion of a Leica ophthalmic microscope. Visualization of the surgical case was on a 55 inch OLED 6 foot from the surgeon. The display was a circular polarization, passive stereoscopic display and all members of the surgical team wore lightweight stereo viewing glasses.

Results : All surgical cases were completed without reverting to an optical microscope. Cases included vitreoretinal procedures and cataract surgery. The ability to view and surgically deal with pathology was similar to routine optical microscope surgery however the brightness of the image and the ability to enhance the stereo were advantages over optical microscopy as was increased engagement of surgical staff. Lag time between movement and its visualization was only perceptible with fast gross movements which were not part of surgical procedures.

Conclusions : The DAVS system was uniformly concluded to offer advantages with no disadvantages over optical stereo microscopic viewing in vitreoretinal and anterior segment surgery. Stereo perspective was enhanced as was brightness and engagement by the operating room personnel. This system will permit a variety of improvements including increased resolution and development of auxiliary imaging devices and in the future will likely connect to surgical instruments allowing heads up control and display.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.