Heads-up 3D Microscopy: An Ergonomic and Educational Approach to Microsurgery

Purpose: Microsurgery performed with traditional binocular eyepieces can lead surgeons to use neck and back postures that cause discomfort and musculoskeletal fatigue.¹ As a result of poor posture, surgeons are more prone to work-related neck and back injuries and potentially shorter operative careers.^2-3 A new technology from TrueVision projects the microscope optical image onto a three-dimensional (3D), high resolution flat-screen display allowing surgeons to operate while sitting or standing in a heads-up position. This also enhances the viewing members' learning experience and the microsurgeon's ability to interact with the student. The purpose of this study is to evaluate the feasibility of performing heads-up 3D microscopy as a more ergonomic and educational alternative to traditional microsurgery.

Methods: A pilot study was created where rat femoral artery (Sprague-Dawley type, average weight 350-grams) anastomoses were performed by eight microsurgeons using 3D heads-up microscopy. The TrueVision camera apparatus was attached to a standard surgical microscope which projected a 3D high-definition image displayed onto a 1080p flat-screen monitor. Three-dimensional goggles were used to visualize the image. A questionnaire was used to evaluate image quality, comfort and technical difficulty and to compare these measures with each microsurgeon's experience with traditional microsurgery.

Results: Rat femoral artery anastomoses were successfully carried out by all eight microsurgeons. One-hundred percent of subjects rated neck, upper back and lower back comfort throughout the heads-up procedure to be superior to traditional microsurgery. Seventy-five percent found depth perception, field of view and technical feasibility with heads-up microscopy to be equivalent or superior to traditional microsurgery, while 63% evaluated image resolution to be superior or equivalent.

Conclusions: 3D heads-up microscopy is feasible and may allow for a more ergonomic approach to microsurgery without compromising image quality or technical ease. Its use has become prevalent in the fields of ophthalmology and otolaryngology and there may be a role for its use in Plastic and Reconstructive Surgery.

References:

1. Yu D, Sackllah M, Woolley C, et al. Quantitative posture analysis of 2D, 3D, and optical microscope visualization methods for microsurgery tasks. Work. 2012;41 Suppl 1:1944-7.

2. Wallace RB 3^rd. The 45-degree tilt: improvement in surgical ergonomics. J Cataract Refract Surg. 1999 Feb;25(2):174-6.

3. Bhadri PR, Rowley AP, Khurana RN, et al. Evaluation of a stereoscopic camera-based three-dimensional viewing workstation for ophthalmic surgery. Am J Ophthalmol. 2007 May;143(5):891-2.