Modus-V Exoscope Gives MUSC Surgeons a New Perspective

Ramin Eskandari, M.D.

by Kat Hendrix

The world of surgical imaging with microscopes, endoscopes and fluoroscopes is being turned upside down by a revolutionary new technology: the exoscope. An exoscope is a high-definition digital imaging system that enables surgeons to see a magnified, three-dimensional (3D) image of the surgical field during microsurgeries such as procedures on the brain, eyes and spinal cord. In a unique partnership with Synaptive Medical, Inc., the Medical University of South Carolina (MUSC) has installed two Modus-V exoscopes as part of its mission to provide the most advanced health care technology available to people in South Carolina and across the Southeast.

"We are the first hospital in North America to have their whole 3D operating room system with all of the newest innovations to help surgeons see better," says Ramin Eskandari, M.D., an associate professor of neurosurgery at MUSC.

Eskandari helped spearhead this groundbreaking partnership with Synaptive after meeting the CEO, Cameron Piron, at a training course for another Synaptive technology.

"This was about five years ago and, at the time, Synaptive only had around 70 employees, who were all engineers and physicists. There was no marketing or sales department," says Eskandari. "Cameron was really trying to get people interested in what they were doing, and he invited me to bring a team up to see their tractography system, a navigation system for tracking nerve networks in deep brain structures. So I got a group of people together from different areas — neurosurgery, neuroradiology and pediatrics — and while we were there, he showed us a visualization of the Modus-V exoscope, which was still in its infancy. It was really amazing! Everyone on that trip was excited about helping them develop this new technology."

Sunil Patel, M.D., a professor of neurosurgery at MUSC, was in that group and clearly remembers the Modus-V presentation. "It was this complete paradigm shift in neurosurgical imaging. I have a physics background, and when I saw how the technology was designed, I was just taken aback — it was such a leap forward. I remember thinking, 'OMG! I am looking at the future.'"

The MUSC team instantly recognized that the innovations they had seen would be a game changer for surgeons and their patients. Eskandari says, "When we saw the technology, we were determined to play a part of its development. We introduced them to the innovation accelerator program at MUSC's Zucker Institute of Applied Neurosciences, which was created to help neuroscience experts in surgery and medicine turn ideas into new products and devices for surgical and nonsurgical procedures. We've made this really great triangular partnership between us on the clinical side, their engineering and technology experts, and the folks at ZIAN who can move it all forward."

Partnering with forward-thinking innovators like Synaptive is consistent with one of MUSC's guiding principles, which emphasizes the importance of innovating to develop new solutions for health care challenges. While traditional operating microscopes rely on lighting and magnification to enlarge surgical field images, the exoscope uses image processing technology that was developed for taking telescopic pictures of distant galaxies. This allows it a wider field of view and greater focal depth, which reduces the need to reposition the scope and removes the need to refocus it during procedures.

Eskandari explains, "With an exoscope, the camera is above the operating field and your head is upright, looking straight ahead, not down like with the microscopes we usually use. With the Modus-V you see the image on a big 55-inch screen and you have peripheral vision. But the biggest advantage is that you have a 3D image. Everyone in the operating room puts on 3D glasses, and everyone can see exactly what the surgeon is seeing."

Patel agrees that this is a significant advantage. "The nurses and techs all know what's happening, so they can plan and prepare for the next steps of the procedure. This also makes it a really great teaching tool," Patel says.

The Modus-V system incorporates innovative software that enables the camera to track small movements of the surgeon's hands and automatically keep the image properly lit and focused. "You're looking at this large screen and doing surgery while the camera watches where your hands are going and adjusts automatically to follow. The physics of the camera and lighting mean it keeps perfect focus. So, unlike a microscope, you don't have to refocus it yourself," says Patel.

Although there is a learning curve to using an exoscope, the technology represents an exponential improvement in surgical field imaging. In fact, it is predicted that the exoscope will replace the traditional operating microscope which allowed surgeons to first undertake microsurgery in the 1960s and has been used ever since.

With an exoscope, surgeons no longer have to look through the microscope itself. This eliminates many limitations of human anatomy that have long plagued surgeons, who often spend hours standing or sitting in uncomfortable positions during surgery. Eskandari explains, "You're not staring down into the surgical field with your chin on your chest. You can move the camera around to see into areas and look at angles you'd never be able to see with a microscope. Your head just can't turn certain ways, and therefore you would not have been able to see those views with the traditional microscope. With an exoscope, there is no limit to the angles and views you can get."

Greater ergonomic comfort makes surgical procedures faster and more thorough, producing exponential benefits to patients. "It takes hours off of long surgeries because instead of moving around physically very slowly, you can just move the camera. This system lets us do surgery safer and faster, which is really important, especially in children, because it reduces anesthesia time. Less time under anesthesia is linked to much better cognitive outcomes, especially in very young children. It also lets us make smaller incisions so we're able to do more surgery with less injury. All of these advantages are linked to better outcomes," says Eskandari.

It is even more exciting that the Modus-V initiative is only the beginning of MUSC's collaboration with Synaptive, which has many more projects in the pipeline.