The next breakthrough in surgical imaging has arrived in Birmingham at Princeton Baptist Medical Center. Orbeye, the video microscope by Olympus, looks like a sleek, elongated Coke can on a stalk and delivers high-definition, 3D digital images in real time to surgeons. Gone are the ocular lenses, replaced by 3D glasses that resemble mod sunglasses, making the surgical team look futuristic in the darkened operating room.
"It was liberating," says Hossein Aziz, DO, an orthopedic spine surgeon at Princeton Baptist, about his first time using the 3D microscope. "I felt fresher. I could bring the instruments in at different angles to get a more thorough decompression, safer decompression--meaning working around the nerves and cleaning up the tissue around the nerves."
Aziz, who has no conflicts of interest with Orbeye, trained throughout his surgical residency and fellowship using a traditional microscope but was introduced to the 3D microscope during his fellowship at UAB when the university had a trial with the device.
"From a surgeon's perspective, the ergonomics are night and day," Aziz says. With the classic microscope, surgeons must constantly lean forward to look into the eye piece set over the incision. "You can imagine that some spine surgeries can take hours, and that position can increase body fatigue. With the 3D microscope, you're looking at a TV at eye level, so you stay fresh during the case, which contributes to better surgery for the patient."
With large TV screens on mobile stands viewable from each side of the surgical table, everyone in the operating room can see exactly what the surgeon sees. "It keeps everyone in the operating room more engaged," Aziz says. "The anesthesiologist can see if there's more blood in the field than usual, and can lower their pressure accordingly and safely; your neurophysiologist can see what part of the procedure you're at, so it allows them to stay with you; and the implant rep can anticipate the next step and keep the scrub tech on point with getting equipment ready. None of that is possible with the traditional microscope."
Aziz had no trouble adapting to the digital scope. "Maybe it was the orthopedic background, because we're used to arthroscopy, where you're looking up at a TV while working with your hands with instruments. It felt natural," he says. The only learning curve was memorizing the floor buttons for moving the microscope.
The 3D device offers autofocus, a zoom function, and four times the resolution of standard HD imaging. "It means you have better depth perception, which is huge when you're operating in a very small field," Aziz says. "Add on top of that, it's hard to differentiate depth of tissue. With 3D you can get better perception of the depth in the individual planes so you can be sure you're working safely and doing a complete decompression or complete surgery." Illumination even surpasses the classic microscopes due to the non-heat, LED light passing through fewer optical lenses.
The fewer mechanics of the digital microscope has also simplified and automated focusing and adjustments, which has given surgeons greater access. In orthopedics, the ocular microscopes with knobs and gears make it hard to shoot down into certain disk spaces, such as into the curvature of the cervical spine when working from the front. "With 3D, it's small, more compact, and has much more freedom of mobility. The camera can rotate and shoot perfectly down that disk space and give you a beautiful shot at it," Aziz says. "So it can show you things that the traditional microscope has difficulty with on top of giving more depth perception and 4D definition."
Despite the advances in detail and viewing perspectives, the device has not yet expanded the types of surgeries available in orthopedics. But it could make current procedures possible in more extreme spaces in the spine where the traditional microscope could not reach.
"The device is very user-friendly," Aziz says. "There is less configuration needed as compared to the standard microscope. It boots up in 15 seconds and is ready to use within a few minutes. And the footprint is so small that you can have a standard microscope in the operating room as a backup, if you don't like it."
Aziz has performed four spinal procedures with the Orbeye in its first month at Princeton Baptist. Having just arrived at the hospital, orthopedics is currently the only specialty actively using the device, with neurology looking into it now. But nationwide, neurology, pediatrics, ENT, and urology have found its 3D, HD capabilities useful.
"There is a trend and a push for augmented reality with respect to surgery. You can see that with navigation and robotic surgery, and I think this device plays right along with that," Aziz says. "In 10 to 15 years, I can see this being the standard."
