Since 1922 and the first documented use of a lighted binocular microscope which took place during a live operation, the surgical microscope has been considered to be an essential tool.
This tool firstly gained widespread acceptance in neurosurgical procedures, and now it is heavily used in the surgical practice of dentistry, gynecology, reconstructive medicine, ophthalmology, and urology.
The main and simple purpose of this type of microscope is to provide a better view for the surgeon and improve the usual components of microscopy, resolution, illumination, and magnification.
However, new aspects like size, viewing, stability, recording capabilities, positioning, and the ability to integrate with surgical tools that are image-guided should be taken into consideration when designing and using this tool.
Important Features
The modern surgical microscope can be placed on a tabletop, mounted on a stand, or worn on the surgeon’s head. It can also be hung on the wall or ceiling to reduce using the floor space in the surgical suite. With today’s technology moving at a rapid pace, it can now be mounted on an AI robotic stand & arm.
Binocular Head
A basic feature of a binocular head is adjustable eyepieces. The ability to attach another head for an assistant also called a teaching head, will allow two people to work with magnification at the same time in the operating field. The head should be able to pivot independently and have individual magnification levels. It’s better if the head can be retrofitted with a camera to allow the user to document the procedure on disk or SD cards and also to allow colleagues to view the operation in real-time.
Foot Controls
This is used to focus, tilt, and zoom. This is essential because it will allow the surgeon’s hands to be free to continue the operation without interruptions.
Illumination
This is also important to maximize the capabilities of the microscope. The principal types of illumination used with this microscope are fiber optic, incandescent, and halogen. It is fundamental to have the ability to accurately adjust its intensity.
Magnification
Extreme magnification is not much of an important feature for a surgical microscope. It is usually set in three to six presets with a range of 6x to 25x. What’s more important for a surgical microscope is a wide field of view.
Other factors that are needed to be considered are internally routed cables and antimicrobial-coated surfaces. Internally routed cables are more important because lighting, documentation, and controls need wiring. Having no wiring can get in the way of the surgical team and harbor bacteria.
Since this can be pricey, buying a surgical microscope that is flexible enough to be used for different medical specialties is a cost-effective solution. Most of these instruments are flexible to meet general surgical needs. However, for ophthalmic procedures, the surgical microscope is designed differently.
The binocular head of an ophthalmic microscope is canted at an angle as much as 45 degrees unlike microscopes for other procedures that are straight. Also, ophthalmic microscopes need specialized lighting, focusing, and magnification requirements.
Zeiss Surgical Microscopes
The pioneer of the modern model of surgical microscopes can be accredited to The Zeiss Corporation in 1953.
Their early innovations, improvements, and upgrades were focused on scalability, lighting methods, and decreasing their size to limit intrusion in the field. But nowadays, their focus is patient data storage, area of documentation, and fluorescence microscopy.
OPMI Pentero
Zeiss offers several multidisciplinary microscope systems, and yet, its OPMI Pentero series holds the latest available technology.
This system can be mounted on the ceiling when not in use and has activation to lower down over the patient. It offers precise XY positioning, instant magnification change, and can incorporate tools that are intraoperative tools to give aid to the surgeon.
Three fluorescence tools increase the usefulness of the Zeiss surgical microscope. Those are the Infrared 800, Flow 800, and Blue 400.
The Infrared 800is a fluorescence-based angiography tool that allows the surgeon to view the vascular circulation at the surgical site. This enables them to identify the direction and sequence of blood flow with continuous color mapping.
Flow 800 is an analytical tool that is used with the Infrared 800. With the fluorescence video sequences that are generated by Infrared 800, the Flow 800 will allow the surgeon to compare before and after an arterial function. This is very essential in neurosurgical procedures.
The Blue 400, on the other side, will help the surgeon target and resect tumors. This one is crucial in removing brain tumors because though the surgeon’s goal is to excise the whole tumor, the healthy tissue should not be removed. Every brain tissue is functional that’s why resection of brain tumors is a special concern.
With the use of appropriate filters and special light sources, fluorescence illumination will be able to accurately fix and define the edges of the tumor.
There is another module that is available for this microscope that can export images from the microscope to the picture archiving and also a communications system to allow instant viewing on any other PC or laptop connected to the network. What’s good is that the information can then be directly linked to the patient’s records.
Zeiss also offers OPMI VISU series of microscopes that are designed for ophthalmic procedures and OPMI Vario and OPMI Neuro for minimally invasive spinal surgery. All of these have different lighting options. While touch screen controls are standard, foot controls are an option to be added.
Leica Microsystems
Aside from developing its system of fluorescence microscopy, Leica was the first to design a head-mounted microscope.
HM500
This microscope can be used in all types of surgeries. Aside from offering the advantage of hands-free operation, this gives the surgeon the freedom to move around the patient. It can switch between a 9x magnification, which is focused on a higher resolution, and 2x magnification, which is focused on a wider view of the whole field. Also, you can attach a camera to document and display the procedure for the other surgical staff that might be assisting in the operation, or research.
Leica M520 and M720 Systems
This one is also versatile and can be used in all types of surgeries. But, it’s still better to use a specialized microscope when it comes to ophthalmic procedures. These are considered the premium microscopes used for neurosurgical procedures. These systems can be used with image-guided surgical tools with their motorized focus and magnification. Its xenon arc illumination also provides bright illumination. An essential factor that M720 has to offer for neurosurgical applications is its redesigned optical head that is more compact than others.
M844 Ophthalmic Microscope
These offer standard features like on other high-quality surgical microscopes and direct halogen lighting that’s meant to create sharp contrast and accurate color at low levels.
Leica M320 Series
This microscope focuses on otolaryngology and dental markets. Though this has a small floor footprint, maneuverability, and LE lighting, this has less sophisticated controls than others. But on the bright side, it’s easy to sterilize and has internally routed cables. It also offers high-definition recording on SD cards.
FL400
This one is Leica’s oncological fluorescence package. This system allows the surgeon to quickly switch from bright white light to blue fluorescence to be able to view the tumor’s outlines. This can also record the entire procedure in high definition.
Leica Ultra Observer
With its six observation ports, this provides visualization not just for the surgeon but also for three assistants and two video or camera adapters. Leica has Dual Imaging technology that provides data matching techniques for image-guided surgical correlation and allows the display of patient data on the microscope.
Other Manufacturers
Topcon
Topcon Medical offers two ophthalmic microscopes and a general one. Features included are LCD Fare, small footprint, a foot control which is programmable, optional XY translator, teaching head, and reducing optics.
Visine Industries
The scopes offered by this have camera attachments and beam splitters, floor stand or table clamps, and a selection of filters.
Globe Surgical manufactures three dental microscopes and two otolaryngology microscopes. These are typically small and bear a hug from the wall or ceiling and are even mounted on a floor stand.
Nikkon and Olympus
Both of these do not manufacture on this particular branch of microscopy but Olympus offers several endoscopes to view the interior of body cavities and organs in an invasive manner.
Surgical microscopes eventually graduated from being a luxury to a necessity for operating rooms.
Aside from the magnification it provides, it also offers documentation and display of patient data. You can also resect tumors with fluorescence microscopy.
To choose the best microscope, scalability is the key. With this, you can add flexibility and it gives you the ability to add other advances in this field of microscopy.
