Surgeons have highlighted the “significant” protective advantages of Alcon’s Ngenuity 3D Heads-Up Display System during retinal surgery amidst the COVID-19 pandemic.
Ophthalmologist Dr Keith Small, who operates at Wellington and Bowen Hospitals in New Zealand, said Ngenuity’s headsup system was recently acquired by his department to enable operations to proceed in full personal protective equipment (PPE), should this become necessary.
“In March this year, four vitreo-retinal surgeons in our department found ourselves test-fitting full PPE. Faced with the prospect of significant numbers of COVID-19 patients in our community, we expected that sooner or later we would be looking after patients with blinding eye diseases who also were infected with the virus,” said Dr Small.
While, at the time of going to print, New Zealand had no community transmission of COVID-19, he noted there were 27 positive cases within the country’s in-bound isolation facilities. Additionally, elsewhere in the world, the disease was far from under control.
“A further outbreak here remains a possibility, and around the globe, the challenge of providing sight-saving surgery at an appropriate time, while also minimising the risk of COVID–19 being contracted by clinical staff, is not going away quickly,” Dr Small said.
It was when being fitted with PPE that Dr Small and his colleagues first realised it would not be possible, while wearing full PPE, to sit with their eyes sufficiently close to the eye pieces of an operating microscope while performing a procedure.
“We had already trialed the Alcon Ngenuity high definition surgical viewing system and had submitted a Capex request for this, as we believed it had the potential to significantly improve surgical visualisation for both the surgeon and all operating room staff. However, the realisation that this ‘heads-up’ system would allow us to operate in full PPE, if necessary, became the persuasive argument to purchase the system.”
HIGH DEFINITION IMAGING
As with the comparable Zeiss Artevo 800 viewing system, the Alcon Ngenuity system uses a large high definition screen on which a two channel 3D image is displayed. The surgical image is captured by a high definition camera which replaces the oculars on any operating microscope. The surgeon, and potentially everyone in the operating room, can view the images via polarising 3D spectacles.
Dr Small says images can be manipulated to enhance many optical variables, improving depth perception and fine definition. This maximises the visualisation of delicate intraocular manipulations, such as peeling or dissecting semi-transparent epiretinal membranes – that are a few tens of microns thick – off the surface of retinal tissue that itself is at most, only a third of a millimeter thick.
SAFER SURGERY, POWERFUL TEACHING
Describing the experience of using the 3D technology as “extraordinary”, Dr Small said it could potentially make retinal and other intraocular surgery safer, as well as being a powerful teaching tool for others in theatre.
Simon Auty, charge nurse at Bowen Hospital, believes that by facilitating greater collaboration in theatre, the system is already leading to improved patient safety and outcomes.
“3D visualisation allows the entire team to wear full PPE during surgery. That means they can all see and participate in the surgery more fully, which enhances collaboration,” explained Mr Auty.
“Nursing staff in the theatre can more actively collaborate with the surgeon as they have the exact same view, making anticipation of the surgeon’s requirements easier. The team can be more fully involved, noticing pathology that they previously couldn’t see, or may have missed, and also asking and learning about the features they are seeing in 3D.”
OTHER SAFETY CONSIDERATIONS
While 3D systems give surgeons the option of operating in full PPE if necessary, Dr Small says there are other important considerations in a world where we are likely to meet patients with COVID–19 and imminently sight threatening conditions.
“Other issues to consider include the importance of good surgical site draping to eliminate the potential passage of aerosolised viral particles from the patients’ upper airway into the surgical field. We also need to be aware of the potential for virus to be shed from the conjunctival surface.
“The decisions around whether to delay surgery until the patient is no longer infectious (thereby risking greater permanent visual loss) remain challenging. We are very mindful our colleagues in other countries, with a much higher COVID-19 burden, will already have been grappling with this problem.
“Nonetheless, we believe that the added protection afforded by being able to operate in full PPE is another significant advantage of these new and exciting surgical viewing systems,” Dr Small concluded.