New operational modes also allow significant impact for anatomy instruction. New robotic movements positively assist the surgeon and provide improved ergonomics and a greater level of intraoperative comfort, with the potential to increase the viewing quality. Improvements of the robotic visualization platform include intraoperative fluorescence visualization using FNa, integrated micro-inspection tool, improved ocular imaging clarity, and exoscopic mode. We present illustrative cases highlighting utility and new ways to control the operative microscope. Endoscopic assistance was used for around-the-corner views in minimally invasive approaches.
3D exoscopic function was successfully used in brain tumor and spine cases. Pivot point control was particularly useful in deep surgical corridors with dynamic retraction. Point lock and pivot point functions were used in dissections to create 3D virtual reality microsurgical anatomy demonstrations. Near-infrared indocyanine green imaging 3-step replay allowed for more convenient accurate assessment of blood flow. PpIX visualization was comparable to the previous microscope. The robotic microscope showed higher sensitivity for fluorescein sodium, higher detail in non-fluorescent background, and recorded/presented pictures with color quality similar to observation through the oculars. Usability and functionality were tested in the operating room over 1 year. In a neurosurgery research laboratory, we performed anatomical dissections and assessed robotic, exoscopic, endoscopic, fluorescence functionality. We assessed a new robotic visualization platform with novel user-control features and compared its performance to the previous model of operative microscope.
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