Dr Ilan Sebban using the Ngenuity system to train staff
Ophthalmologist Dr Ilan Sebban has become the first surgeon on Sydney’s northern beaches to install Alcon’s Ngenuity 3-D visualisation system.
This heads-up display system includes a high dynamic range (HDR) camera with impressive resolution, image depth and colour contrast.
Unlike using a traditional microscope, when a surgeon uses Ngenuity, they view the surgical field in 3D on a screen, and can increase magnification while maintaining a wide field of view, or digitally highlight ocular structures.
mivision asked Dr Sebban about the difference Ngenuity has made to him, his team and his patients.
When launched, Ngenuity was described as “a bit expensive” – having installed the system, what do you think?
Given the additional enhancements Ngenuity provides to a surgeon’s view, in terms of increased resolution, depth of field and magnification, I don’t believe it is a substantial investment. Moreover, it integrates with the current microscope, phaco machine and Callisto (toric alignment tool).
While it was not a deal breaker for the hospital, because we could have continued to use the existing microscope, investing in NGenuity enhanced the visualisation of the microscope and expanded its lifespan.
Once you feel comfortable with the view, you can then start to explore the digital filters and utilise the Centurion phaco data presented before you
How did you find Ngenuity physically fitted into the surgery and how did it change the workflow?
The surgical display is 140cm and is attached to a cart that houses the image processor. It is a big unit, but once you incorporate it into the surgical flow, it becomes part of the theatre and only takes two to three minutes to set up. I ensure all right eyes and left eyes are grouped together on a list to improve efficiency and minimise the need to move the screen.
Were there any challenges in adapting this technology?
Moving to digital visualisation is an all or nothing decision. In other words, commitment is the key. While it turned out to be an easy process, it is important to have everyone in the theatre on board and comfortable, as you will need to make small adjustments to the operating layout and process. Getting it right can take time.
What was the training process like for you, as a surgeon?
Without the extensive field support provided through the trial process, uptake would be low. Alcon does a great job in normalising the experience and, given the future of intraocular surgery, moving from analogue to digital is an inevitable paradigm shift. A key initial step is to ensure the surgeon parfocalises, focusing simultaneously on all planes, from the back of the cataract to the cornea, to achieve the enhanced depth of field and resolution. After a few cases you start to feel more confident and your surgical technique does not need to change. Once you feel comfortable with the view, you can then start to explore the digital filters and utilise the Centurion phaco data presented before you.
3D technology opens the door to future advancements incorporating data from the clinic, intra-operative OCT, endoscopy and image optimisation, which can only benefit patients outcomes
How does Ngenuity make a difference to you when performing back-to-back surgeries?
The surgical view for a surgeon is significantly better compared to a traditional microscope. Particularly when inserting iStents (MIGS), I can work under high magnification with excellent clarity.
Being presbyopic, not having to refocus my microscope throughout the case adds to efficiency, and having the Centurion phaco data present on the screen gives me more control.
Ergonomically, Ngenuity has made a positive difference too. Being able to sit away from my microscope oculars has improved my neck and back posture, which was becoming a problem. This technology, therefore, allows me to operate more comfortably – I feel better during and after the surgical list by sitting with improved posture. This, I expect, will also extend my career longevity.
The real game changer for me is live teaching. Furthermore, Ngenuity offers the opportunity to share my surgical technique through 3D recordings that include valuable phaco data, such as CDE values and vacuum/aspiration flow foot positions.
How do you describe the difference Ngenuity makes to working with and teaching your team?
For the first time, everyone in the theatre is able to share the same view as the surgeon. This assists with their understanding of, and engagement with, the procedure and flow of the surgical case. They can pre-empt what instruments I will need, making the surgical process more efficient. In the words of many nurses, “cataract surgery used to be so boring”.
Are there any cautionary notes you’d offer practices considering Ngenuity?
It is important to trial this technology on a variety of cases in order to feel comfortable before being able to explore the true benefits 3D visualisation has to offer. This is part of the future. Now all we have to hope for is nano robotic technology.
What difference do you believe Ngenuity makes to patient outcomes?
Digital imaging significantly enhances the surgical field, which in turn improves surgical outcomes for the patient. I found that previously, when using the analogue microscope, dense cataracts would certainly have corneal oedema post-operatively. Now I have been surprised that these same dense cataracts have much clearer corneas at day one post-op. I can explain this by the fact that the anterior chamber is significantly more magnified, and I have much more accurate focus of the position of the phaco tip in relation to the corneal endothelium and iris plane. In other words, increasing control over the case results in safer and improved outcomes for the patient. Furthermore, Ngenuity allows the surgeon to use less light compared to a microscope, which reduces the risk of phototoxicity (light damage to the macula) to the patient.
Lastly, 3D technology opens the door to future advancements incorporating data from the clinic, intra-operative OCT, endoscopy and image optimisation, which can only benefit patients’ outcomes.