The Department of Neurosurgery at the Icahn School of Medicine at Mount Sinai is one of the first hospitals in the country to use the ZEISS KINEVO 900 microscope, a surgeon-driven, robotic visualisation system that merges the functionality of a surgical microscope with 4K resolution and 3D visualisation along with specialised robotic control.
Optical, navigation, and simulation information are streamed into the microscope’s eyepiece and projected on large monitors in the operating room, providing a detailed perspective for the operating room staff, including co-surgeons, surgical assistants, and medical residents, who can all view the high-resolution images in real time. 3D glasses provide an enhanced visualisation of neuroanatomy.
“An important question for neurosurgeons has always been, where is the best place to view optical information from the microscope—should one look through the eyepieces as we’ve done traditionally, or should that information be gathered by high-resolution video and projected on a monitor,” said Joshua Bederson, MD, Professor and System Chair for the Department of Neurosurgery at Mount Sinai Health System and Clinical Director of the Neurosurgery Simulation Core.
Dr. Bederson says one advantage to projecting real-time images of the brain onto a video screen is that information sources from outside the microscope can be overlaid on the monitor. This augmented reality includes navigational guidance that alerts the surgeon to 'no-fly zones'—neuroanatomy that should be avoided during surgery.
The KINEVO 900 utilises an open interface that allows for integration with navigation and image-guided software developed by the medical technology companies Brainlab and Surgical Theater.
“The analogy is the heads-up-display that aircraft pilots have when they’re looking at navigation information during flight,” said Dr. Bederson, a licensed pilot. “The operating room of the future is one that integrates multiple information sources streamed into the surgeon’s viewpoint in a way that is non-distracting and can be used in the service of patient safety.”
KINEVO 900 has several features that are the first of their kind, including a specialised robotic control system called PointLock, which enables the surgeon to focus on a particular point in the surgical field and move the microscope in a spherical arch without losing focus, with the use of a foot pedal.
This allows the surgeon to navigate safely around the patient during surgery as opposed to repositioning the patient. PositionMemory stores magnification and focus settings for key regions of the brain.
A micro-inspection surgical tool called QEVO is engineered with an angled design, allowing the surgeon to look around complex structures that are out of the microscope’s range.
“Our team of neurosurgeons is driving and advancing the development of next-generation simulation and virtual reality technology, which can help improve patient outcomes and solve neurosurgical challenges,” said Dr. Bederson.
The Icahn School of Medicine at Mount Sinai purchased the two robotic visualisation systems with the generous support of a donor who wishes to remain anonymous. Dr. Bederson is an expert in skull-base and cerebrovascular surgery and has performed more than 3,700 neurosurgical operations at Mount Sinai. Dr. Bederson owns equity in Surgical Theater, LLC.