3-D Visualization System for ‘Heads Up’ Strabismus Surgery
Maanasa Indaram; Benjamin G. Jastrzembski, MD; Medha Sharma, MD; Yoshihiro Yonekawa, MD; Deborah K. VanderVeen, MD;
David G. Hunter, MD, PhD; Ankoor S. Shah, MD, PhD
Boston Children’s Hospital, Massachusetts Eye and Ear Infirmary
Introduction: ‘Heads up’ surgery provides three-dimensional (3D) images of the surgical site in straight-ahead gaze. This has gained popularity in vitreoretinal surgery due to improved visualization and illumination, ergonomics, and surgical team involvement. We present early experiences with the system in strabismus surgery, outlining benefits and limitations.
Methods: We conducted a retrospective review of strabismus surgeries completed using the NGENUITY 3D Visualization System (Alcon and TrueVision® 3D Surgical). We surveyed involved surgeons and staff for their experiences with this technology.
Results: Three patients underwent uncomplicated strabismus surgery with excellent oculomotor outcomes using the 3D visualization system. Surgeries included inferior rectus recession, bilateral horizontal muscle recession-resection, and reoperation on a slipped lateral rectus muscle. Reported advantages of ‘heads-up’ surgery included improved illumination, posture, magnification, and better visualization for staff and trainees. Reported disadvantages included atypical positioning of the surgeon at the head of the bed for horizontal muscle surgery, atypical assistant views as the display is in the surgeon’s perspective, increased operative time/cost, mild distortion of depth and color, and decreased space due to extra equipment.
Discussion: ‘Heads up’ surgery may improve strabismus surgery through better visualization leading to consistent scleral suture depth, easier vertical rectus muscle surgery, and easier deep orbit maneuvers such as posterior fixation or muscle splitting. It may also improve teamwork and education through engagement of staff and trainees. Lastly, posture benefits may decrease surgeon fatigue and extend careers.
Conclusion: While ‘heads up’ strabismus surgery offers advantages, outcomes data must be generated and disadvantages must be addressed prior to mainstream use.
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