Tag: ergonomics

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Operative Microscope In-Field Visualization of Confocal Laser Endomicroscopy Interface (Zeiss CONVIVO )

Operative Neurosurgery 29:860–864, 2025

This study evaluates integrating the Zeiss CONVIVO confocal laser endomicroscopy interface into the operative microscope heads-up display to allow simultaneous visualization of the surgical field and real-time confocal laser endomicroscopy (CLE) images. A randomized cohort of 22 intra-axial tumor surgeries showed shorter CLE usage times, fewer total captures, and a trend toward higher usable-image proportion with heads-up integration.

The integration improved intraoperative ergonomics by reducing probe motion artifacts and image noninterpretability, streamlining workflow, and decreasing operative time while preserving diagnostic utility of CLE for margin assessment in gliomas and other brain lesions.

Confocal Laser Endomicroscopy (CLE): Provides real-time, in vivo microscopic imaging of brain tumors during neurosurgery, enabling identification of tumor margins without the need for traditional tissue extraction or frozen section analysis.

Zeiss CONVIVO® System: A CLE device recently introduced in neurosurgery, proven reliable for both ex vivo and in vivo applications, and undergoing further clinical refinement.

Technical Challenge: Standard CLE use requires the surgeon to shift attention from the operative field to a separate screen to assess image quality, potentially causing motion artifacts, prolonging surgery, and increasing the number of unusable images.

Heads-Up Display Integration: Visualization of the CONVIVO® interface was integrated as a picture-in-picture display inside the operative microscope, allowing simultaneous monitoring of the surgical field and CLE images without diverting gaze.

Study Findings: Use of the heads-up display significantly reduced CLE employment time (mean 61.1 vs. 201.6 seconds; P = .01), decreased the total number of images acquired, and increased the proportion of usable images, though the latter was not statistically significant (P = .06).

Workflow Efficiency: Direct intraoperative feedback enabled by the heads-up display led to fewer motion artifacts, more efficient image acquisition, and reduced overall operative time.

Clinical Implications: The integration supports more efficient and accurate intraoperative tumor assessment, potentially improving the extent of resection, especially in gliomas, and reducing reliance on frozen sections.

Limitations and Future Directions: Further refinement is needed for effortless image acquisition; artificial intelligence for artifact reduction and real-time interpretation by neurosurgeons are potential future improvements.

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Posterolateral lumbar spine fixation and decompression with navigation interfaced with a robotic exoscope with head mounted display

Acta Neurochirurgica (2024) 166:342

Lumbar spine fixation and fusion is currently performed with intraoperative tools such as intraoperative CT scan integrated to navigation system to provide accurate and safe positioning of the screws. The use of microscopic visualization systems enhances visualization and accuracy during decompression of the spinal canal as well.

Methods We introduce a novel setting in microsurgical decompression and fusion of lumbar spine using an exoscope with robotized arm (RoboticScope) interfaced with navigation and head mounted displays.

Conclusion Spinal canal decompression and fusion can effectively be performed with RoboticScope, with significant advantages especially regarding ergonomics.

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Neurovascular Microsurgical Experience Through 3-Dimensional Exoscopy

World Neurosurg. (2023) 174:63-68

The microscope is important in neurosurgery, but it is not exempt from limitations. The exoscope has emerged as an alternative because it offers better 3-dimensional (3D) visualization and better ergonomics. We present our initial experience in vascular pathology using 3D exoscopy at the Dos de Mayo National Hospital to show the viability of the 3D exoscope in vascular microsurgery. We also provide a review of the literature.

METHODS: In this work, the Kinevo 900 exoscope was used in 3 patients with cerebral (2) and spinal (1) vascular pathology. We evaluated the image quality, equipment management, ergonomics, educational utility, and 3D glasses and recorded the characteristics of the cases. We reviewed the experience of other authors as well.

RESULTS: Three patients underwent surgery: 1 occipital cavernoma, 1 cerebral dural fistula, and 1 spinal dural fistula. Excellent 3D visualization with Zeiss Kinevo 900 exoscope (Carl Zeiss, Germany), surgical comfort, and educational utility occurred, and there were no complications.

CONCLUSIONS: Our experience and that of other authors suggests that the 3D exoscope shows excellent visualization, better ergonomics, and an innovative educational experience. Vascular microsurgery can be performed safely and effectively.

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The force pyramid: a spatial analysis of force application during virtual reality brain tumor resection

J Neurosurg 127:171–181, 2017

Virtual reality simulators allow development of novel methods to analyze neurosurgical performance. The concept of a force pyramid is introduced as a Tier 3 metric with the ability to provide visual and spatial analysis of 3D force application by any instrument used during simulated tumor resection. This study was designed to answer 3 questions: 1) Do study groups have distinct force pyramids? 2) Do handedness and ergonomics influence force pyramid structure? 3) Are force pyramids dependent on the visual and haptic characteristics of simulated tumors?

METHODS Using a virtual reality simulator, NeuroVR (formerly NeuroTouch), ultrasonic aspirator force application was continually assessed during resection of simulated brain tumors by neurosurgeons, residents, and medical students. The participants performed simulated resections of 18 simulated brain tumors with different visual and haptic characteristics. The raw data, namely, coordinates of the instrument tip as well as contact force values, were collected by the simulator. To provide a visual and qualitative spatial analysis of forces, the authors created a graph, called a force pyramid, representing force sum along the z-coordinate for different xy coordinates of the tool tip.

RESULTS Sixteen neurosurgeons, 15 residents, and 84 medical students participated in the study. Neurosurgeon, resident and medical student groups displayed easily distinguishable 3D “force pyramid fingerprints.” Neurosurgeons had the lowest force pyramids, indicating application of the lowest forces, followed by resident and medical student groups. Handedness, ergonomics, and visual and haptic tumor characteristics resulted in distinct well-defined 3D force pyramid patterns.

CONCLUSIONS Force pyramid fingerprints provide 3D spatial assessment displays of instrument force application during simulated tumor resection. Neurosurgeon force utilization and ergonomic data form a basis for understanding and modulating resident force application and improving patient safety during tumor resection.

 

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