Laboratory evaluation of a robotic operative microscope - visualization platform for neurosurgery

Reading this brief overview does not substitute the reading of the original study, but is just giving an abridged insight and is not necessarily reflecting the opinion of notified bodies and/or regulatory authorities.

Original title:
Laboratory Evaluation of a Robotic Operative Microscope - Visualization Platform for Neurosurgery

Authors:
Belykh E G, Zhao X, Cavallo C, et al.

Source: Belykh E G, Zhao X, Cavallo C, et al. (July 30, 2018) Laboratory Evaluation of a Robotic Operative Microscope - Visualization Platform for Neurosurgery. Cureus 10(7): e3072. doi:10.7759/cureus.3072

Operative microscopes have become fundamental to the success of modern neurosurgical and other surgical specialty procedures that they are requisite for a modern standard of care. Operative microscopes have become active platforms for the development of improved user-control interfaces and robotic systems. Latest developments provide significantly more functions than previous operative microscopes. Below text is only a reference and does not replace reading the original study.

A one-year study was recently conducted to perform a comprehensive assessment of the new, cutting-edge KINEVO^® 900 from ZEISS, a first-ever Robotic Visualization System^® and compares its performance to the previous model of ZEISS surgical microscope. This study was carried out in a neurosurgery research laboratory. The assessment covered robotic, exoscopic, endoscopic and fluorescence functionalities. The study found that the KINEVO 900 provides a number of improvements over the previous surgical microscope.

Several novel robotic functions integrated into the KINEVO 900 were found provide improved ergonomics, with a potential to increase the viewing quality of neurosurgical procedures, including the illumination and visualization. For example, the “PositionMemory” and “PointLock” functions of the KINEVO 900 were found likely to be helpful in procedures requiring small bone windows. Additionally, there is no need to constantly adjust the parameters of the microscopic visualization during surgery. Considering that up to 40% of total surgery duration is spent adjusting the microscope, this technology could serve to decrease operative time.   

The 3D 4K Digital Hybrid Visualization of ZEISS KINEVO 900 was found to be a significant improvement over prior technology. With the exoscopic visualization mode and long working distance, the entire operative room team can appreciate the detailed structures in the depth of surgical corridor. Furthermore, the 3D widescreen exoscopic view increases educational value. The study found that it was feasible to perform microvascular suturing and other microsurgical manipulations when the KINEVO 900 was used as an exoscope with the 3D view.   

Other notable improvements found with the KINEVO 900 over the previous ZEISS system include improved intraoperative fluorescence visualization. The KINEVO 900 provides better discrimination between the fluorescent signal and the surrounding area by means of a significantly improved perception of brain and blood colors. Non-fluorescent tissues appeared much brighter and more natural in color with the KINEVO 900 digital display and slightly brighter through oculars compared to the previous system.

The KINEVO 900 provided a novel augmented reality ICG overlay function, better image resolution, and improved post-processing workflow for quantification of the flow compared to the previous ZEISS systems. FLOW^® 800 from ZEISS was shown to be clinically beneficial to detect ischemic brain regions, differentiation of the feeders and draining vessels in arteriovenous malformations and quantitative evaluation of microanastomosis patency. This study showed that ICG angiography was sensitive enough to assess blood flow even in small vessels less than 1 mm diameter with similar quantitative results.

Endoscope assistance in microscope-operated intracranial surgeries offers an additional visualization of the deep structures. However, endoscope assistance is limited by a decrease or at least significant impediments in maneuverability when compared with using the operative microscope. The KINEVO 900 is a robotic visualization platform that solidifies integration of microscopic and exoscopic visualization with a micro-inspection angled endoscope. This fully integrated Micro-Inspection Tool, QEVO^® from ZEISS, allowed inspection of areas around the resection cavity. The combination of two views in a picture-in-picture format enables a safer and efficient way to perform endoscope assisted procedures.

The Micro-Inspection Tool, QEVO enabled in identifying blind spots to resect hidden portions of the cavernous malformation. The post-operative imaging confirmed a gross total resection and the patient was observed returning back to full strength one month after the surgery.   

In all, the improvements made in the KINEVO 900, along with the fully integrated endoscopic Micro-Inspection Tool, are significant. These improvements will influence ergonomics, precision, efficiency, viewing quality, and educational value of surgical procedures, providing that surgeons receive suitable training in its optimal use.