Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.
Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.
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DOI：
10.1038/srep31689
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发表时间：
2016-08-19
影响因子：
4.6
通讯作者：
Izatt JA
中科院分区：
文献类型：
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作者：
Carrasco-Zevallos OM;Keller B;Viehland C;Shen L;Waterman G;Todorich B;Shieh C;Hahn P;Farsiu S;Kuo AN;Toth CA;Izatt JA
微创显微手术改善了患者的预后。然而，通过显微镜操作限制了深度感知并固定了视觉视角，这导致了陡峭的学习曲线，以达到显微手术的熟练程度。我们介绍了一种手术成像系统，采用四维（实时体积成像通过时间）显微镜集成光学相干断层扫描（4D MIOCT）能够成像高达10卷每秒可视化人类显微手术。定制的立体平视显示器为外科医生提供实时交互式体积反馈。我们报告称，在涉及17名眼科医生的模拟手术试验中，4D MIOCT增强了手术的准确性和对器械定位的控制。此外，在48例人眼手术中进行了4D MIOCT成像，并证明在93%的视网膜手术中成功可视化了与术前诊断一致的感兴趣病理，在100%的眼前节手术中成功可视化了感兴趣手术部位。体内4D MIOCT成像显示了在标准手术操作期间通过手术显微镜不可见的表面下病理结构和器械诱导的病变。在选定病例中，需要4D MIOCT引导来解决此类病变并预防术后并发症。我们的新型手术可视化平台实现了外科医生交互式的实时手术4D可视化，可以扩展外科医生的能力。
Minimally-invasive microsurgery has resulted in improved outcomes for patients. However, operating through a microscope limits depth perception and fixes the visual perspective, which result in a steep learning curve to achieve microsurgical proficiency. We introduce a surgical imaging system employing four-dimensional (live volumetric imaging through time) microscope-integrated optical coherence tomography (4D MIOCT) capable of imaging at up to 10 volumes per second to visualize human microsurgery. A custom stereoscopic heads-up display provides real-time interactive volumetric feedback to the surgeon. We report that 4D MIOCT enhanced suturing accuracy and control of instrument positioning in mock surgical trials involving 17 ophthalmic surgeons. Additionally, 4D MIOCT imaging was performed in 48 human eye surgeries and was demonstrated to successfully visualize the pathology of interest in concordance with preoperative diagnosis in 93% of retinal surgeries and the surgical site of interest in 100% of anterior segment surgeries. In vivo 4D MIOCT imaging revealed sub-surface pathologic structures and instrument-induced lesions that were invisible through the operating microscope during standard surgical maneuvers. In select cases, 4D MIOCT guidance was necessary to resolve such lesions and prevent post-operative complications. Our novel surgical visualization platform achieves surgeon-interactive 4D visualization of live surgery which could expand the surgeon’s capabilities.