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Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.

Publication ,  Journal Article
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
Published in: Sci Rep
August 19, 2016

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.

Duke Scholars

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Published In

Sci Rep

DOI

EISSN

2045-2322

Publication Date

August 19, 2016

Volume

6

Start / End Page

31689

Location

England

Related Subject Headings

  • Tomography, Optical Coherence
  • Surgery, Computer-Assisted
  • Ophthalmologic Surgical Procedures
  • Monitoring, Intraoperative
  • Microsurgery
  • Humans
 

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Carrasco-Zevallos, O. M., Keller, B., Viehland, C., Shen, L., Waterman, G., Todorich, B., … Izatt, J. A. (2016). Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography. Sci Rep, 6, 31689. https://doi.org/10.1038/srep31689
Carrasco-Zevallos, O. M., B. Keller, C. Viehland, L. Shen, G. Waterman, B. Todorich, C. Shieh, et al. “Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.Sci Rep 6 (August 19, 2016): 31689. https://doi.org/10.1038/srep31689.
Carrasco-Zevallos OM, Keller B, Viehland C, Shen L, Waterman G, Todorich B, et al. Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography. Sci Rep. 2016 Aug 19;6:31689.
Carrasco-Zevallos, O. M., et al. “Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.Sci Rep, vol. 6, Aug. 2016, p. 31689. Pubmed, doi:10.1038/srep31689.
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. Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography. Sci Rep. 2016 Aug 19;6:31689.

Published In

Sci Rep

DOI

EISSN

2045-2322

Publication Date

August 19, 2016

Volume

6

Start / End Page

31689

Location

England

Related Subject Headings

  • Tomography, Optical Coherence
  • Surgery, Computer-Assisted
  • Ophthalmologic Surgical Procedures
  • Monitoring, Intraoperative
  • Microsurgery
  • Humans