by Lisa Chamoff
, Contributing Reporter | April 09, 2018
From the April 2018 issue of HealthCare Business News magazine
At first, Bederson is not able to see the patient's carotid artery through the microscope. Although the artery is well visualized on the preoperative MR, it is hidden by the tumor.
The location of the artery – considered a dangerous "no-fly zone" – is visible in the form of a dotted red outline on Bederson's heads-up display and on the high-resolution OR monitor. The monitor can be seen by OR staff and a few students from the Icahn School of Medicine who have come to observe the hours-long surgery. The red lines show the position of the artery, tracking its position when the microscope is moved. As the surgery gets closer to it, the anatomy is confirmed with an intraoperative ultrasound, permitting safe removal of the tumor from around the artery.
Despite the advantages of the technology, Bederson says the surgery is not as successful as he’d hoped it would be. Most of the tumor, which is very vascular and fibrous, is located up high in the patient’s brain, and will likely require a more invasive craniotomy.
Looking to the future
Bederson and the Mount Sinai network are on the cutting edge when it comes to surgical technology, and Mount Sinai’s neurosurgery department is also one of the first hospitals to take things to the next level by using the new KINEVO 900 neurosurgical visualization microscope from Zeiss.
The device – which Bederson tested last October and two of which were purchased with the help of a donation from a former patient – feeds optical, navigation and simulation information into a 55-inch 4K 3-D monitor.
“Instead of looking through eyepieces, I’m looking at the video image obtained by the KINEVO,” Bederson explains. “The quality of the heads-up display information that’s injected into the eyepieces is limited because the eyepieces are optimized for optical information provided by the microscope. They’re not well suited for digital information. The information is pixelated and it’s really not as high-quality as it could be. So, we’re actually dumbing down the quality of the digital information to facilitate microscope integration.
“Now, because everything’s a video feed, we can increase the quality of that digital information.”
The KINEVO 900 also allows for surgeon-controlled robotic movement of the microscope, so instead of Bederson having to stop what he’s doing and move the microscope, he can identify a point in the patient and the microscope will only move in relation to that focal point.
Going forward, there will also be image-controlled robotic movement.