Video Telescope Operating Monitor for Spine Surgery

28 Video Telescope Operating Monitor for Spine Surgery

Doniel Drazin and Adam N. Mamelak

28.1 Introduction

A recent advent in operative technology is the “exoscope.” This is a rigid rod lens system that looks and functions much like standard endoscopes but has a long focal distance of 25 to 30 cm and is positioned outside the surgical cavity. The exoscope is used with a mechanical or pneumatic scope holder that permits rapid repositioning and refocusing. The device has been termed the video telescope operating microscope, or VITOM (Karl Storz Endoscopy, Tuttlingen, Germany; Fig. 28.1). Since operative surgical visualization is performed from the monitor, the surgeon is able to sit or stand in a comfortable, arms flexed position, with minimal strain on his neck or arms, thereby reducing surgical fatigue and endpoint tremor. The authors have previously reported their surgical experiences with this system in limited aspects of intracranial surgery (pineal region, posterior fossa) as well as in surgery on the spine.^1,2,3

28.2 VITOM: Components

The VITOM consists of a rigid lens telescope, camera head, light source, and video display monitor(s).

28.2.1 Exoscope

The exoscope is an 8-mm autoclavable rigid lens telescope (Model E1051–1, Karl Storz Endoscopy, Tuttlingen, Germany) with a 10-mm outer diameter and a shaft length of 14 cm (Fig. 28.2).

28.2.2 Light Source

A commercially available 300-W xenon fiberoptic light source (Xenon Nova 300, Karl Storz) is used (Fig. 28.3).

28.2.3 Camera Head

The camera head is a 3-chip sterilizable high-definition (HD) digitized camera (HD A3, Karl Storz), with optical zoom and focus features (Fig. 28.4).

28.2.4 Video Display and Documentation

A medical-grade 23-inch HD (2 million pixels) video monitor (NDS Surgical Imaging, San Jose, CA) is used (Fig. 28.5).

28.2.5 Telescope Holder

The telescope is held in position by a pneumatic endoscope holder (UniArm, Mitaka Kohki Company, Tokyo, Japan) with a wide range of motion. The device allows for push-button rapid repositioning with minimal drift (Fig. 28.6).

Fig. 28.1 (a) The VITOM (Karl Storz Endoscopy, Tuttlingen, Germany). (b) The operating room set up with the VITOM exoscope, camera, and light attached to a pneumatic holder, and dual video monitors. (c) A close-up view of the VITOM system.