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Surgical Microscopy

What does a surgeon expect from a surgical microscope? Sharp, clear images, flexibility and ease of use, and high-quality video and recording systems. Surgeons in the fields of neurology, ophthalmology, otolaryngology (ENT) and plastic reconstructive surgery rely on operating microscopes to magnify their view of the surgical site and provide information beyond what is visible to the naked eye.

In recent years, surgeons have benefitted from many technological innovations that have enhanced microscope performance, expanded the array of available diagnostic and operative tools, and ultimately improved surgical outcomes and patient wellbeing. Some examples of recent developments in surgical microscopy include: compact horizontal optics, increased reach and overhead clearance for optimum maneuverability, ergonomically-designed microscopes and accessories to improve surgeon posture and comfort, fully integrated HD video and recording in 2D and 3D, intraoperative fluorescence to see blood flow or brain tumors, and stable red reflex.

In this topic on Science Lab, we will report on state-of-the art technologies for microsurgery disciplines, publish interviews with surgeons and provide expert knowledge.

  • How Intrasurgical OCT can Impact the Surgical Approach to Membrane Peeling

    When treating patients with vitreomacular traction (VMT), peeling of the inner limiting membrane (ILM) or an epiretinal membrane (ERM) is often indicated. Successful outcomes depend on precise surgical maneuvers as well as the surgeon’s experience in order to assess whether the entire membrane has been removed, as this is crucial for successful release of traction. Showing different steps of removing an ERM to resolve VMT, the following videos captured with EnFocus intrasurgical OCT demonstrate how visualization of the membrane can impact the surgical process of membrane peeling.
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  • Full-HD Image Injection Provides a Complete Picture of the Surgical Site Directly in the Microscope Eyepieces

    The human skull is an especially delicate area for surgery. To differentiate healthy tissue from tumor cells, or treat an aneurysm for example, the surgeon needs a complete picture of the surgical area. Supplementary information provided by Image Guided Surgery (IGS) or neuro navigation systems, endoscope, and in some cases fluorescence, can support the surgeon’s visualization, insight and intra-surgical orientation. This supplementary visual information is often only viewable on a separate screen, but with image injection technology from Leica it can be overlaid in full high definition (HD) directly into the eyepieces of a surgical microscope.
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  • Navigating Through the Brain

    One of the challenges of neurosurgery is orientation at the surgical site. When resecting tumors, removing arteriovenous malformations, or clipping aneurysms, surgeons often have to work near healthy and functional brain tissue. When resecting the tumor, the challenge is always to spare as much healthy tissue as possible. Neuronavigation technology, also referred to as Image Guided Surgery (IGS) enables surgeons to plan the ideal approach before making a cut and helps to execute that plan by providing intraoperative orientation.
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  • Sylvian dissection with ICG, viewed with FL800 fluorescence

    In vascular and neoplastic surgery sylvian dissection is an essential skill. The neurosurgeon needs to recognize the superficial sylvian vein (SSV) in order to safely and accurately achieve a wide opening of the sylvian fissure. A report by Dr. Hisashi Kubota and his colleagues at the Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan, discusses the benefits of indocyanine green (ICG) videoanigiography to demarcate the SSV at the beginning of a sylvian dissection, particularly in patients with subarachnoid hemorrhage. Observation of ICG was enabled by an FL800 vascular fluorescence module from Leica in combination with an M525 OH4 neurosurgical microscope.
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  • Good Reasons why to use a Dental Microscope – Interview with Endodontist Dr. Thorsten Wegner

    With its high magnification and coaxial illumination, a dental microscope provides enhanced visualization that supports diagnosis and treatment. Its documentation capabilities also play a major role in a modern dental practice by supporting patient consultation. We interviewed Dr. Thorsten Wegner, an endodontist based in Stadthagen, Germany, to find out why he uses the microscope in all aspects of his dental practice.
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  • How to Acquire High-Resolution Anatomic Ocular Tissue Information with Optical Coherence Tomography (OCT)

    Optical Coherence Tomography (OCT) is a non-invasive, non-contact imaging modality used to visualize and monitor changes to the morphology of biological tissue. OCT employs low-coherence interferometry to create cross-sectional images that reveal sub-surface details of the tissues of interest. In the most common ophthalmic applications OCT systems use near-infrared light to generate high-resolution, volumetric images of tissue microstructures including the cornea, iris, crystalline lens, vitreous and retina. These images can enhance insight into pathological conditions such as glaucoma, age-related macular degeneration or diabetic retinopathy.
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  • How Intrasurgical OCT can Provide Additional Information During Ophthalmic DMEK Procedures

    Replacing diseased Descemet’s membrane with a donor graft is an especially delicate procedure. Accurate positioning and full adherence to the stroma are crucial for optimal patient outcomes. These videos illustrate how intrasurgical OCT can provide additional information during each stage of a DMEK procedure.
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  • Successful Endodontic Treatment Supported by a Dental Microscope

    In endodontics, accurate treatment is not only dependent on the technical skills and knowledge of the dentist, but also on clear, detailed visualization of the surgical field. As the outcome of an endodontic therapy is influenced by many factors that are not visible to the naked eye – e.g. additional root canals or anatomical variations – the high magnification and illumination provided by a dental microscope has become indispensable for both diagnosis and therapy. Today, it is widely agreed that the use of dental microscopes has helped to extend endodontic treatment potential.
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  • Webinar: Current Applications and Advances in Fluorescence-guided Surgery

    Participants will receive an overview on the concept of fluorescence-guided surgery (FGS) for the resection of brain and spinal cord tumors. Neurosurgeons will understand the current technologies available for FGS and the different tumor types that can undergo FGS. Safety, diagnostic accuracy, and Level 1 evidence in support of FGS will also be discussed.
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  • "The excellent red reflex, combined with the IOL guidance system, makes it possible for me to work quickly and precisely during refractive procedures."

    Excellent red reflex as well as maximum accuracy throughout the entire procedure are required to meet these expectations. Dr. Ulrich Jung, Medical Director at the ARTEMIS eye clinic in Dillenburg, Germany, tested the Proveo 8 ophthalmological microscope from Leica Microsystems in combination with the positioning system IOLcompass Pro for intraocular lenses at his clinic. In this interview, Dr. Jung reports his experiences.
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  • How to Manage Critical Points in Cataract or Refractive Surgery with IOL Positioning Software

    Successful refractive surgery is all about accuracy. The aim is to deliver minimal residual astigmatism so the patient can be glasses- free. Latest IOL Positioning Systems such as IOLcompass Pro deliver precise, dependable and dynamically optimized guidance information designed to minimize inaccuracy throughout the entire process. This comparison highlights the impact on a typical cataract surgery using toric IOLs.
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  • The Dental Microscope in Endodontics

    In dentistry a bright, magnified view into deep cavities supports detailed diagnosis and precise therapy, particularly in the field of endodontics. In this interview Dr. Dean Raicov explains the benefits of the dental microscope in his practice. Dr. Raicov is a dentist based in Röhrnbach, Germany and specializes in endodontics, parodontology, and prosthetics. He is a member of the European Society of Microscope Dentistry (ESMD) and the German Society of Endodontics and Paradontology.
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  • Cataract and Glaucoma Surgery with the Proveo 8 Ophthalmic Microscope

    These videos recorded during cataract and glaucoma surgery using Proveo 8 demonstrate how Dr. Ahmed benefits from continuous red reflex even during phaco, due to exclusive CoAx 4 coaxial illumination, and high resolution combined with depth of focus for a texture-rich view due to FusionOptics technology.
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  • Is iOCT the Next Paradigm Shift for Vitreoretinal Surgery?

    Intraoperative ocular coherence tomography (iOCT) is a useful asset when performing macular surgery and other vitreoretinal procedures. Considering the advantages it provides, iOCT may be the next paradigm shift in vitreoretinal surgery according to Justis P. Ehlers, MD.
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  • Six Features to Consider when Choosing a Dental Microscope

    In dental medicine, the surgical microscope has become increasingly important for high-quality and successful surgeries, particularly in the field of endodontics. A microscope supports the dentist to conduct micro-invasive surgeries which aim to preserve the tooth substance, conserve the tissue, minimize the risks and reduce healing time. To choose the microscope that best fits the dentist’s needs, it is helpful to know some of the decisive features of a modern dental microscope.
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  • How a State-of-the-Art Microscope Helps to Optimize the Workflow in Cataract Surgery

    Typical ophthalmic procedures require specific levels of light, focus and magnification in each phase of surgery. Changing quickly between these settings is the prerequisite for an uninterrupted and smooth workflow where the surgeon can concentrate completely on his patient. The surgical microscope for ophthalmology Proveo 8 features a unique level of customization that allows to program complete surgical phases and single parameters. Dr. Devesh Varma is one of the first ophthalmologists having tested the Proveo 8 microscope.
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  • 3D Visualization in ENT Surgery

    3D visualization of microscopic images not only offers advantages for neurosurgery and ophthalmology, but also provides important benefits for ENT surgery and training. In this interview, Prof. Erwin Offeciers talks about his experiences with 3D visualization in ENT surgery. He is head of the European Institute for Otorhinolaryngology - Head & Neck Surgery of the Sint-Augustinus Hospital in Antwerp, Belgium, and manages Skillslab, the hospital’s own training center for head and neck surgery, neurosurgery and obstetrics & gynaecology.
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  • The Impact of a Stable Red Reflex and Enhanced Focus in Cataract Surgery

    In cataract surgery, ophthalmologists rely on the red reflex which provides ideal contrast to visualize the capsule, lens and anterior chamber structure. A new illumination technology in the latest of ophthalmic microscopes now appears to provide great breadth of red reflex enhancement throughout the entire procedure. Dr. Ike Ahmed is one of the first ophthalmologists having tested the Proveo 8 microscope which features the CoAx4 illumination.
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  • Cataract Surgery with CoAx4 Illumination

    A stable red reflex is one of the most important features of an ophthalmic surgical microscope for cataract surgery. It’s the red reflex that makes the structure of the lens visible and thus makes for a uncompromised view for a successful and secure surgery. However, conventional red reflex illumination often decreases during the critical phases of the procedure like phacoemulsification. A new illumination technology with four individual beam paths overcomes these drawbacks.
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  • Intraoperative OCT Today and Tomorrow: The PIONEER Study Two-year Results and Beyond

    The high-resolution, cross sectional information provided by iOCT creates a unique feedback system for vitreoretinal surgery. The PIONEER Study conducted by the Cole Eye Institute is a three-year exploratory study to investigate clinical feasibility, the impact on surgical decision-making, and the potential safety of a microscope-mounted portable iOCT. PIONEER represents the largest study to date examining the feasibility, utility, and safety of iOCT.
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  • Video Talk by Sonia H. Yoo: Interoperative OCT Imaging of Selective Lamellar Keratoplasty

    The work prepared and presented within this video demonstrates preliminary research, and the promising future of perioperative OCT to aid the diagnosis of physiological and pathological conditions during ophthalmic surgery in order to help guide surgical decision making in anterior segment cases. Showing SDOCT Images acquired with an Envisu SD-OCT system, Prof. Yoo demonstrates the use of interoperative OCT imaging several important surgical procedures such as DALK, DSAEK and DMEK.
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  • Video: Traumatic Soft and Hard Tissue Wound on the Maxillary Anterior with Microscope Assisted Rehabilitation

    The concept of minimal intervention dentistry became a primary approach to treat carious lesions. These days, this concept could be adapted to manage soft tissue around the teeth and implants as a minimally invasive technique. This video, we show a case of traumatic soft and hard tissue wound on the maxillary anterior and its rehabilitation. The patient was a 22 year-old women, and her chief complaint was severe aesthetic disorder because of her trauma. She lost two incisor teeth as well as tissue and bone around the teeth.
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  • A Brief History of MIGS (Microinvasive Glaucoma Surgery)

    Ike Ahmed, the man who coined the term Micro-Invasive glaucoma surgery (MIGS), has helped open a new flank in the battle to reduce intraocular pressure, ushering in the next generation of surgical approaches and devices. In The Ophthalmologist he shares the story behind his pioneering and controversial journey into microinvasive glaucoma surgery (MIGS).
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  • First Bilateral Hand Transplant in a Child – Microsurgical Reconstruction with the Help of a Leica M525 F40 Surgical Microscope

    Surgeons at The Children’s Hospital of Philadelphia (CHOP) joined with colleagues from Penn Medicine recently to complete the world’s first bilateral hand transplant on a child. Earlier this month, the surgical team successfully transplanted donor hands and forearms onto 8-year-old Zion Harvey who, several years earlier, had undergone amputation of his hands and feet and a kidney transplant following a serious infection.
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  • Video: How Optical Innovations and 3D Heads-up Surgery Help to Improve Ophthalmic Surgery

    In this video, Dr. Ike Ahmed demonstrates how optical innovations help to improve ophthalmic surgeries. In addition, he talks about his experience with 3D heads-up surgery, using a stereoscopic high-definition visualization system for cataract, glaucoma, and retinal surgeries.
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  • Video: Implant Microsurgery – Microscope-­aided Maxillary Sinus Floor Elevation, Lateral Window Technique

    The lateral window technique is a method of maxillary sinus floor elevation which enables implant placement in the maxillary posterior region where the maxillary sinus is enlarged and/or the alveolar bone height is deficient. When creating a lateral window, great care should be taken not to perforate the maxillary sinus membrane.
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  • FusionOptics in Neurosurgery and Ophthalmology – for a Larger 3D Area in Focus

    Neurosurgeons and ophthalmologists deal with delicate structures, deep or narow cavities and tiny structures with vitally important functions. A clear, three-dimensional view on the surgical field is thus indispensable for the outcome of the operation and the patient’s safety. Until now, an increased depth of field for a larger three-dimensional area in focus was only achievable by reducing the resolution. A new technology is able to overcome this challenge.
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  • 7 Tips For Better Ergonomics in Neurosurgery

    Pain and muscle tension are common phenomena in a neurosurgeon’s workday: 78% of neurosurgeons surveyed reported pain after a day of surgery, 83% of these had musculoskeletal pain. By its nature, neurosurgery requires compromising positions. However, with a few simple steps and the right ergonomic accessories for the surgical microscope, the working environment in the OR can be made as comfortable as possible.
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  • New Paths in Glaucoma Therapy – Operation Video Supports Knowledge Transfer in Eye Surgery

    If medication and laser techniques have no prospect of success in the treatment of glaucoma, surgery is essential to stop further damage to the optic nerve. A new surgical method is showing promising results for reducing the potential complications of an operation. Professor Dr. Dr. h.c. Franz Grehn, Director of Würzburg University Eye Hospital, has developed the new method and produced a video to accompany a clinical comparison study. This film was awarded the Video Award 2013 sponsored by Leica Microsystems at the 111th Congress of the German Ophthalmological Society.
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  • Ergonomically Designed Surgical Microscopes Support Performance

    Operations not only demand maximum concentration of the surgeon but also maximum physical fitness. Physiotherapist John Ludescher explains how the body can be given optimal support to perform at its best. The Austrian qualified as physiotherapist in Switzerland and has had his own practice for nine years. He is the author of the book “Aufrecht – Bewusst – Stark” (Upright – Aware – Strong) and designer of the “PhysioCap”.
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Useful Links

Neurosurgery Journals

http://thejns.org/
Journal of Neurosurgery (JNS) – Official Journal of the AANS

http://journals.lww.com/neurosurgery/pages/default.aspx
Neurosurgery

http://jnnp.bmj.com/
Journal of Neurology, Neurosurgery & Psychiatry (with Practical Neurology)

http://www.surgicalneurologyint.com/
Surgical Neurology International (SNI)

http://link.springer.com/journal/10143
Neurosurgical Review

www.thieme.com/index.php?page=shop.product_details&flypage=flypage.tpl&product_id=1379&category_id=90&keyword=journal+neurological+surgery&option=com_virtuemart&Itemid=53
Journal of Neurological Surgery

http://journals.lww.com/spinejournal/pages/default.aspx
Spine

www.karger.com/Journal/Home/224132
Stereotactic and Functional Neurosurgery

www.karger.com/Journal/Home/224273
Pediatric Neurosurgery

www.worldneurosurgery.org/
World Neurosurgery – Official Journal of the World Federation of Neurosurgical Societies (WFNS)

http://www.eans.org/pages/about-us/journalActa Neurochirurgica: The European Journal of Neurosurgery – Official Organ of the European Association of Neurosurgical Societies (EANS)

http://informahealthcare.com/loi/bjn
British Journal of Neurosurgery

https://www.thieme-connect.de/ejournals/toc/zblneurochir
Central European Neurosurgery

http://www.springer.com/medicine/orthopedics/journal/586
European Spine Journal

https://www.jstage.jst.go.jp/browse/nmc
Neurologia Medico-Chirugica – Official Journal of the Japan Neurosurgical Society

http://jkns.or.kr/
Journal of Korean Neurosurgical Society

Ophthalmology Journals

www.scimagojr.com/journalrank.php?category=2731
Journal rankings for category "Ophthalmology"

www.wjgnet.com/2218-6239/
World Journal of Ophthalmology

www.aaojournal.org/
Ophthalmology, the official journal of the American Academy of Ophthalmology

www.ajo.com/
American journal of ophthalmology

http://bjo.bmj.com/
British Journal of Ophthalmology

www.djo.harvard.edu/
Digital Journal of Ophthalmology

www.springer.com/medicine/ophthalmology/journal/10792
International ophthalmology

http://archopht.jamanetwork.com/journal.aspx
JAMA Ophthalmology

http://journals.lww.com/internat-ophthalmology/pages/default.aspx
International ophthalmology clinics

www.springer.com/medicine/ophthalmology/journal/10384
Japanese journal of ophthalmologyhttp://www.benthamscience.com/open/toophtj/

www.benthamscience.com/open/toophtj/
The open ophthalmology journal

http://journals.lww.com/co-ophthalmology/pages/default.aspx
Current opinion in ophthalmology

http://informahealthcare.com/loi/sio
Seminars in ophthalmology

www.iovs.org/
Investigative ophthalmology and visual science

www.dovepress.com/clinical-ophthalmology-journal
Clinical ophthalmology

www.hindawi.com/journals/jop/
Journal of ophthalmology

www.revophth.com/
Review of ophthalmology

www.surveyophthalmol.com/
Survey of ophthalmology

www.sciencedirect.com/science/journal/00084182
Canadian Journal of Ophthalmology/Journal Canadien d'Ophtalmologie

www.sciencedirect.com/science/journal/13194534
Saudi Journal of ophthalmology

www.healio.com/journals/jpos
Journal of pediatric ophthalmology and strabismus

www.elsevier.com/journals/taiwan-journal-of-ophthalmology/2211-5056
Taiwan Journal of ophthalmology

www.eur-j-ophthalmol.com/
European journal of ophthalmology

www.apaophth.org/eJournal/
Asia-Pacific Journal of ophthalmology

www.meajo.org/
Middle East African Journal of ophthalmology

www.ijo.in/
Indian Journal of ophthalmology

www.ajol.info/index.php/njo
African Journals Online – Nigerian Journal of Opthalmology

www.canadianjournalofophthalmology.ca/
Canadian Journal of Opthalmology

www.jao.medrounds.org/
Journal of Academic Ophthalmology

www.ojoonline.org/
Oman Journal of Ophthalmology

www.dog.org/?cat=48
Graefe’s Archive for Clinical and Experimental Ophthalmology

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