University of Florida Surgeons Report High-Tech Spectacles Ease Neck And Back Strain

November 17, 2001

GAINESVILLE, Fla.—Patients going under the knife aren’t the only ones who end up with their share of aches and pains after an operation: Many physicians grapple with substantial neck and back strain by the end of a grueling day in the surgical suite.

Now University of Florida researchers say a pair of lightweight, high-tech glasses could be the prescription for relief. They put the eyewear to the test and found it helped prevent much of the discomfort surgeons experience after performing minimally invasive procedures. These operations usually require surgeons to peer at a small video monitor placed at an awkward angle up to 10 feet away.

The high-resolution glasses project a 52-inch stereoscopic image about six feet into space, enabling doctors to view the operative field no matter where they turn their heads, UF researchers said Saturday (11/17) at the annual meeting of the Association for Academic Surgery in Milwaukee.

“Minimally invasive or laparoscopic surgery has really been a dramatic and revolutionary improvement in the performance of certain procedures, not only for the safety and comfort of patients but also for cost and outcome,” said Dr. Scott Schell, an assistant professor of surgery and of molecular genetics and microbiology at UF’s College of Medicine. “But, in contrast to standard operating procedure where surgeons stand and look down at their hands while operating, during minimally invasive surgery the hands may be pointed in a completely different orientation than where the eyes are looking, because the surgeons are not looking at a wound, they’re looking at a screen. So in lengthy procedures, that practice increases the possibility they could develop neck and back strain, because they’re not in a comfortable position.”

During minimally invasive procedures, surgeons make tiny incisions – some as small as an eighth of an inch – and thread a fiber-optic camera through a catheter to see inside the body. The operation is performed using surgical instruments inserted through the incisions. Depending on the operation, minimally invasive procedures can last anywhere from 30 minutes to eight hours.

“The real issues for the surgeon are: Do you feel like you just had a battle doing this operation? Do you end up having terrible neck and back strain, and is it starting to affect your ability to do the next procedure or to work tomorrow?” said Schell, who also is affiliated with the UF Shands Cancer Center. “After eight or 10 hours of operating, you can really get some significant discomfort.”

Improved digital video cameras and high-resolution video displays have greatly enhanced minimally invasive surgery, UF researchers said, but monitor display size, distance and location have proved to be ongoing impediments to optimal performance. Surgeons wearing the video-projection glasses can look down at their hands while operating-a more natural and comfortable orientation, Schell said. The eyewear is a sophisticated version of a multimedia device manufactured by the Olympus Corp. that consumers use to enhance home theater viewing. It resembles a large pair of sunglasses and weighs about 3.5 ounces.

“The glasses provide a picture of what you’d see inside the abdomen if you opened up the abdomen,” Schell said. “It’s not 3-D. It’s still a 2-D image, but the brain is able to calculate 3-D space based on the stereoscopic view, and you can’t do that with a TV monitor. This lets you see a very large image in both eyes simultaneously and projected in a huge format right in front of you. And the glasses weigh so little, you can look down at the floor or up at the ceiling, but you don’t have to crane your neck around to look at where the monitor was placed in the operating room.”

UF researchers compared how quickly and proficiently 25 surgeons could complete certain tests designed to mimic the essential technical skills commonly used during minimally invasive gallbladder surgery. They also assessed the surgeons’ satisfaction with the glasses, recording their impressions of neck and back strain and visual acuity. Test results were compared with findings obtained from performing the same tasks using a standard flat video display.

The glasses are likely to alleviate some of the physical stress surgeons experience, making their jobs easier, Schell said. On average, surgeons rated their satisfaction with the glasses an average of 4.25 on a scale of 1 to 5, with 5 being ideal. What’s more, the eyewear didn’t slow the surgeons; in fact, speed improved slightly.

“The question then is not how quickly can you do these technically challenging tasks, but whether you can do technically challenging things in a manner that’s fluid and rapid, and can you do it more quickly than with standard procedures, and the answer is yes,” said Schell, adding that UF researchers plan to talk with Olympus about the possibility of producing the device in a U.S. Food and Drug Administration-approved facility and marketing it to surgeons. The glasses could be used in a variety of minimally invasive procedures, such as those designed to remove tumors of the liver or bowel.

A number of new surgical devices feature improved ergonomic designs that surgeons will benefit from, and the glasses are no exception, said Dr. Mark A. Talamini, an associate professor of surgery at the Johns Hopkins University School of Medicine and director of minimally invasive surgery at the Johns Hopkins Hospital.

“Minimally invasive surgery has been wonderful for our patients but tough on the surgeons,” Talamini said. “While operating with foot-and-a-half-long chopstick-type instruments, we often find ourselves in Twister positions for long periods of time, while turning our heads in odd configurations to see the TV screen. Eventually, this takes its toll both on the surgeon and the patient. The glasses reported upon by Schell and colleagues look to be a real giant step in the direction of relieving this strain and improving the surgeon’s visibility. It’s not too hard to believe that if the surgeon can see better, he or she can operate more effectively.”