Orbeye

http://medical.olympusamerica.com/products/orbeye

Olympus, a global technology leader in designing and delivering innovative solutions for medical and surgical procedures, among other core businesses, announced today the launch of its 4K-3D Video Microscope, ORBEYE. The new microscope was developed by Sony Olympus Medical Solutions Inc, (SOMED) a joint venture between Olympus Corporation and Sony Imaging Products & Solutions Inc.

The precise 4K-3D digital images from the new ORBEYE microscope can enable more accurate surgery by providing high-resolution 3D imaging of the structure of tissue, blood vessels and other features. By displaying the progress of surgical procedures on a large 55-inch monitor, the new model has the potential to both reduce surgeon fatigue by eliminating the need for extensive viewing via microscope eyepieces and to include the entire surgical team in the view of the procedure. Because the use of digital technology has made the new microscope unit approximately 95 percent smaller in volume above the surgical field than the previous model, it additionally helps free up surgical space and shortens setup times. The microscope unit was also made 50 percent lighter than the previous model to facilitate its transportation between operating rooms. The device will be marketed by Olympus Corporation.

The benefits of ergonomics, improved precision and ease of positioning in the OR are the result of the following features:

High-resolution 4K-3D digital images supporting precision surgery – The two Sony 4K ExmorRTM CMOS image sensors deliver high-sensitivity, low-noise images. The system deploys an image processing circuit designed to work across a wide color range as well as with four times the pixel count of the Full High Definition standard to provide high-resolution digital images during surgery. Because it additionally minimizes the delay associated with the large amounts of data that need to be processed by 4K-3D systems, ORBEYE provides zero image latency for smoother viewing and manipulation of the target location.

Use of 55-inch 4K 3D monitor helps reduce surgeon fatigue and facilitates team surgery – The new model displays via a monitor and has no eyepiece. This helps reduce surgeon fatigue by allowing a more comfortable working posture without requiring them to spend long periods peering into a microscope lens. Moreover, because the large 55-inch monitor enables the entire surgical team to view the same image, it allows more than one surgeon to operate and improves efficiency by allowing information to be shared with other surgical staff.

Significant reduction in microscope size (95 percent smaller than previous model) helps free up surgical space and shortens setup times – The use of digital technology has made the microscope unit much smaller and it therefore provides the surgeon with additional space to perform operations. The unit’s reduced size also allows faster setup times by eliminating the need to make often awkward adjustments to the balance of the arm, and by allowing use of a smaller and easier-to-fit surgical drape to keep the microscope clean.

“The ORBEYE exoscope represents the next generation of operative imaging- a true quantum shift,” said Dr. David Langer, MD, Lenox Hill Hospital/Northwell Health. “Its adoption is certain and will impact the use of loupe magnification as well as the current operating microscope. The ease of use, surgeon ergonomics and effects upon the operating team are revolutionary and I look forward to continuing to train and develop new strategies for its adoption.”

“We have already received resounding enthusiasm for our 4K and 3D technology for laparoscopy and endoscopy. We are pleased that through the development of ORBEYE, this 4K-3D technology can be offered to more specialties such as neurosurgery, spine, microsurgery, ENT, and cardiac,” said Randy Clark, Group Vice President of the Surgical Division at Olympus America Inc. “We understood that with such complex and lengthy surgeries, the technology would have to be innovative and groundbreaking enough to entice surgeons to make a change, and we were pleased to work with SONY through our SOMED joint venture to meet the challenge.”

The name ORBEYE, a combination of “orb” and “eye”, expresses the idea of being able to approach things from an angle or direction that was not possible using existing microscopes. It also references the product’s potential for global reach.

ORBEYE launched to the healthcare community at the Congress of Neurological Surgeons (CNS) in Boston, October 7-11, 2017.


Murai et al. from Tokyo, reported 22 clinical cases by 5 experienced neurosurgeons and the comparative results of training 10 residents. An observation study with questionnaire survey was conducted on usability. Twelve items including image quality, eyestrain, and function of the arm were evaluated.

The following 22 clinical procedures were conducted: surgery for intracranial hemorrhage (n = 2) and brain tumor (n = 8), laminectomy (n = 3), aneurysm clipping (n = 3), vascular anastomosis (n = 2), carotid endarterectomy (n = 2), and nerve decompression (n = 1). No complications were observed. The fluorescent study, including indocyanine-green and 5-aminolevunic acid, allowed for clear depiction on the 4K monitor. The surgeon could operate in a comfortable posture. Similar to the microscope, it was possible to change the optical and viewing axes with the OE, but the OE was switched to the microscope or endoscope in hematoma removal and pituitary surgeryResidents judged that eyestrain was strong (P = .0096). Experienced neurosurgeons acting as assistants judged that the scope arm’s range of movement was narrow (P = .0204). Sixty percent of residents judged that the OE was superior to the microscope.

Although based on limited experience, it was not possible to substitute the microscope with the OE in all operations; however, the OE surpasses the microscope in terms of ergonomic features 1).

1) Murai Y, Sato S, Yui K, Morimoto D, Ozeki T, Yamaguchi M, Tateyama K, Nozaki T, Tahara S, Yamaguchi F, Morita A. Preliminary Clinical Microneurosurgical Experience With the 4K3-Dimensional Microvideoscope (ORBEYE) System for Microneurological Surgery: Observation Study. Oper Neurosurg (Hagerstown). 2018 Dec 3. doi: 10.1093/ons/opy277. [Epub ahead of print] PubMed PMID: 30508178.

Lipomyelomeningocele

A type of Lipomyeloschisis.

Lipomyelomeningocele, is a closed neural tube defect, taht usually occurs in the lumbosacral area as a single lesion but can be associated with other spinal dysraphism 1) and Caudal regression syndrome.

Represent a unique population within the spectrum of spinal dysraphism.Edit

Pathology

A subcutaneous lipoma that passes through a midline defect in the lumbodorsal fascia, vertebral neural arch, and dura, and merges with an abnormally low tethered cord 2).Edit

Diagnosis

New dynamic MRI-based parameters to establish the presence and magnitude of tethered cord syndrome (TCS) have been defined. oscillatory frequency (OF) measured the extent of loss of translational cord displacement in supine and prone positions; delta bending angle (ΔBA) defined the relative angulation of conus with lower spinal cord, and sagittal and axial root angles represented ventral nerve root stretching. The difference in OF or ΔBA was minimum in the group with thick filum terminale and progressively increased in the groups with lipomyelomeningocele and meningomyelocele 3)Edit

Natural history

The natural history of LMMC remains poorly defined. The description and prevalence of the presenting orthopaedic clinical signs and symptoms for LMMC have been infrequent and often documented only in general terms.Edit

Treatment

Untethering surgery.

An expansile dural graft should be incorporated in cases of lipomyelomeningocele in which primary dural closure does not permit free flow of CSF4).Edit

Case series

In 32 patients with LMMC (21 female and 11 male patients). The majority of patients had their primary tethered cord release (TCR) by ≤1 year of age (59 %), with 22 and 19 % having primary TCR at ages 1-15 and >15 years, respectively. Fifteen patients had at least one repeat TCR, with ten of these having more than one repeat TCR. A significant relationship was noted between low back/radicular pain and repeat TCR (p < 0.001). Ten patients (31%) had a limb length discrepancy of >2.5 cm, and 53 % of patients had asymmetric involvement. Nine patients (28 %) had scoliosis of whom only one required operative treatment. Fifteen patients had foot deformities. Thirteen patients (41 %) had two or more orthopaedic procedures in addition

The presenting musculoskeletal clinical signs and symptoms in patients with LMMC are uniquely different in terms of both pattern and frequency compared to myelomeningocele and other forms of spinal dysraphism.

Its a high prevalence of asymmetrical involvement, a high operative burden, and a high rate of repeat symptomatic tethered cord syndrome requiring TCR. As previously noted by others, TCR in LMMC does not prevent long-term functional deterioration. These findings may be important to our colleagues providing counsel to their patients with LMMC and to their families 5).Edit

Case reports

Fetal lipomyelomeningocele was suspected during the second-trimester ultrasound and confirmed by magnetic resonance imaging. The pregnancy took its course and a term neonate was delivered. At 2 years of age lipomyelomeningocele surgical removal was performed. The patient is now 4 years old and, despite neurogenic bladder, is a healthy boy with normal psychomotor development for his age. This case illustrates the favorable prognosis of this entity and the importance of prompt diagnosis and multidisciplinary counseling 6).Edit

References

Edit1) Hanif H, Khanbabazadeh S, Nejat F, El Khashab M. Tethered cord with tandem lipomyelomeningoceles, split cord malformation and thick filum. J Pediatr Neurosci. 2013 Sep;8(3):204-6. doi: 10.4103/1817-1745.123665. PubMed PMID: 24470813.2) Emery JL, Lendon RG. Lipomas of the Cauda Equina and Other Fatty Tumors Related to Neurospinal Dysraphism.DevMedChildNeurol.1969;11:62–703) Singh S, Behari S, Singh V, Bhaisora KS, Haldar R, Krishna Kumar G, Mishra P, Phadke RV. Dynamic magnetic resonance imaging parameters for objective assessment of the magnitude of tethered cord syndrome in patients with spinal dysraphism. Acta Neurochir (Wien). 2018 Nov 20. doi: 10.1007/s00701-018-3721-7. [Epub ahead of print] PubMed PMID: 30456429.4) Alexiades NG, Ahn ES, Blount JP, Brockmeyer DL, Browd SR, Grant GA, Heuer GG, Hankinson TC, Iskandar BJ, Jea A, Krieger MD, Leonard JR, Limbrick DD Jr, Maher CO, Proctor MR, Sandberg DI, Wellons JC 3rd, Shao B, Feldstein NA, Anderson RCE. Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study. J Neurosurg Pediatr. 2018 Sep 14:1-9. doi: 10.3171/2018.6.PEDS18243. [Epub ahead of print] PubMed PMID: 30215584.5) Segal LS, Czoch W, Hennrikus WL, Wade Shrader M, Kanev PM. The spectrum of musculoskeletal problems in lipomyelomeningocele. J Child Orthop. 2013 Dec;7(6):513-9. doi: 10.1007/s11832-013-0532-5. Epub 2013 Oct 8. PubMed PMID: 24432115.6) Sarmento-Gonçalves I, Cunha M, Loureiro T, Pinto PS, Ramalho C. Fetal lipomyelomeningocele: A closed neural tube defect diagnosed at second trimester ultrasound examination. J Clin Ultrasound. 2018 Nov 8. doi: 10.1002/jcu.22662. [Epub ahead of print] PubMed PMID: 30411358.

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