title: Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.
abstract: 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.
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
authors.forename: O M
authors.initials: OM
authors.lastname: Carrasco-Zevallos
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
authors.forename: B
authors.initials: B
authors.lastname: Keller
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
authors.forename: C
authors.initials: C
authors.lastname: Viehland
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
authors.forename: L
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
authors.forename: G
authors.initials: G
authors.lastname: Waterman
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: B
authors.initials: B
authors.lastname: Todorich
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: C
authors.initials: C
authors.lastname: Shieh
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: P
authors.initials: P
authors.lastname: Hahn
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.|Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: S
authors.initials: S
authors.lastname: Farsiu
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Kuo
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.|Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Toth
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.|Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Izatt
mesh_terms: D006801:Humans; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D041623:Tomography, Optical Coherence / Q000295:instrumentation / Q000379:methods