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Originally a radical concept, the surgical microscope has become an indispensible tool since the first recorded use of a lighted binocular microscope during an operation in 1922.
First used in neurosurgical procedures, this tool is now heavily utilized in the surgical practice of ophthalmology, otolaryngology, plastic and reconstructive medicine, dentistry, gynecology, and urology.
The simple purpose of this microscope is to improve the surgeon’s view and the usual components of microscopy, magnification, resolution, and illumination are important.
However, new aspects such as stability, size, viewing and recording capabilities, positioning, and the ability to integrate with image guided surgical tools must be addressed in designing and using this tool.
The modern surgical microscope can be mounted on a stand, placed on a table top, or worn on the surgeon’s head. Some of them can be hung on the ceiling or wall to conserve floor space in the surgical suite.
Other factors to consider are antimicrobial-coated surfaces and internally routed cables. The latter is important because the controls, lighting, and documentation technology require wiring. Loose wiring gets in the way of the surgical team and can harbor bacteria.
Since this type of microscope is quite expensive, purchasing one that can be used by a variety of medical specialties is a cost effective solution.
Most of these instruments can be adapted to meet general surgical needs; however a surgical microscope used for ophthalmic procedures is designed differently.
On an ophthalmic microscope the binocular head is canted at an angle of as much as 45 degrees while the head on a microscope used for other procedures is straight.
Additionally, an ophthalmic surgical microscope has specialized lighting, focusing, and magnification requirements.
The genesis of the modern surgical scope can be attributed to The Zeiss Corporation in 1953.
Early innovations and improvements focused on lighting methods, scalability of the microscope, and decreasing their size to limit intrusion into the surgical field.
Today the forefront of innovation is in the area of documentation and patient data storage, and fluorescence microscopy.
Zeiss has several multidisciplinary surgical microscope systems, but the OPMI Pentero series incorporates the newest available technology.
This system can be ceiling mounted to be out of the way when it is not in use but touching an activation button will quickly lower it into position over the patient. It has instant magnification change, precise xy positioning, and can incorporate intraoperative fluorescence tools to assist the surgeon.
Image of OPMI Pentero 900 from www.Zeiss.de
The Infrared 800, Flow 800, and Blue 400 fluorescence tools immeasurably increase the usefulness of the Zeiss surgical microscope.
A fluorescence-based angiography tool, the Infrared 800 allows the surgeon to see the vascular circulation at the surgical site and determine the sequence and direction of blood flow with continuous color mapping.
The Flow 800 is the analytical tool used in conjunction with the Infrared 800. Using fluorescence video sequences generated by the Inflared 800, this tool allows the surgeon to compare before and after arterial function. This is very important in neurosurgical procedures.
The Blue 400 allows the surgeon to precisely target and resect tumors. This ability is critical in removing brain tumors because the surgeon certainly wants to completely excise the entire tumor but not unnecessarily remove healthy tissue. This is of special concern in the resection of brain tumors because all brain tissue is functional.
Using a special light source and appropriate filters, this fluorescence illumination tool accurately fixes and defines the edges of the tumor because the tumor fluoresces blue.
Another module is available for this microscope that exports the images from the microscope to a picture archiving and communications system for instant viewing at other terminals on the network. This information can be directly linked to the patient’s records.
Zeiss also makes the OPMI VISU series of microscopes for ophthalmic procedures as well as the OPMI Neuro and OPMI Vario system for minimally invasive spinal surgery.
Most of these microscopes can be integrated with image guided surgical tools and have different lighting options.
Touch screen controls are standard but foot controls may be added.
As well as developing its own system of fluorescence microscopy, Leica designed the first head-mounted microscope.
Topcon Medical manufactures two ophthalmic microscopes and a general purpose surgical scope. Some of their features include:
Visine Industries is another company with a presence in the surgical microscope market.
These scopes have optional beam splitters and camera attachments, a selection of filters, and floor stand or table clamps.
Globe Surgical makes three dental microscopes and two otolaryngology microscope.
Basic microscopes lacking some of the sophisticated features of a Zeiss or a Leica, these units are small and can be hung from the wall or ceiling as well as mounted on a floor stand.
Two major microscope manufacturers, Nikon and Olympus, do not have a presence in this particular branch of microscopy.
Olympus does make several endoscopes to view the interior of body cavities and organs in a minimally invasive manner, but the company does not manufacture a true surgical microscope.
If leasing a microscope would be a more practical solution for you, Surgical Microscopes, LLC leases several models of Zeiss, Leica, and Topcon microscopes.
Here is their link:
Surgical Microscopes, LLC
The surgical microscope has graduated from being a luxury to an operating room necessity.
More than merely providing magnification, new microscopes can record and display patient data and remove the uncertainty from tumor resections by employing fluorescence microscopy.
Scalability is a key consideration in choosing a microscope to add flexibility and the ability to incorporate advances in this field of microscopy.
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