Three-Dimensional Imaging Systems Make Surgery Safer and Quicker : Virtual reality: Devices allow doctors to locate organs and do suturing and other tasks more easily.

Virtual reality is coming to the operating room. Surgeons are testing special video monitors and eye wear, minute cameras and computer processors that give them a three-dimensional, lifelike view inside the body as they operate through tiny incisions.

The systems likely will replace most two-dimensional ones now used for minimally invasive surgery, or MIS. Surgeons perform such operations through keyhole-size incisions; to see what they’re doing, they insert a camera called a laparoscope through another tiny cut, or an endoscope through a body opening.

Because the 3-D systems provide depth perception, surgeons can locate organs and do suturing and other tasks more easily and quickly than by watching a 2-D video monitor.

“It’s as real as it gets. It’s restoring what we would see when . . . you made a big incision,” said Dr. Steven I. Becker, director of The Surgery Center in Fair Lawn.

“Once this is established, this is what we’re going to use for all our cases,” said Becker, who does general surgery, mostly on an outpatient basis.

Becker has been trying out a 3-D system under development by Automated Medical Products Corp. of New York. It uses a single lens, special goggles and computer processors to simulate three dimensions.

More than a dozen companies worldwide are working to develop three-dimensional systems. Three have clearance from the federal Food and Drug Administration to sell their products; some already are on sale overseas.

Manufacturers and some doctors call the new systems a major advance. But some doctors who have tested them say it will be at least a year until needed refinements convince hospitals and surgeons that the equipment is worth its $30,000-plus price tag--two to four times the cost of many 2-D systems.

Nonetheless, professional conferences covering “Virtual Reality in Medicine” are announced nearly every month. And John Ahern, president of Odenton, Md.-based Endo Image Corp., which is developing 3-D systems with and without special eyeglasses, expects the worldwide market for such systems to soon hit $2 billion annually.

“I think you’re going to see the sophisticated surgeons begin to do the procedures in their office,” Ahern adds.

Dr. Michael R. Treat, director of laparoscopic and endoscopic surgery at Columbia-Presbyterian Medical Center in New York City, also predicts a boom in what he calls “augmented reality.” Treat says the systems eventually should be able to show doctors both the 3-D view of the surgery and images from X-rays or other scans.

Manufacturers dream that surgeons eventually will be able to operate on remote patients using the imaging systems and robots, but surgeons say that will only happen if health care reform does not choke off research dollars.

Even without 3-D, minimally invasive surgery has become commonplace in the past five years, particularly for non-emergency abdominal procedures such as appendix, gall bladder and hernia operations.

Because the incisions are so small, patients have less pain, bleeding and risk of infection--and much quicker recoveries. Patients can now go home the same day or morning after operations that once kept people hospitalized for a week.

That sharply reduces treatment expenses, making MIS increasingly popular as insurance companies reduce their costs. Surgeons and manufacturers are sure that trend will continue, and more and more difficult operations will be tried using MIS.

“As they continue to improve the (3-D) equipment, I think it will become the standard of care in three years or so,” said Dr. Bruce V. MacFadyen Jr., president of the Society of American Gastrointestinal Endoscopic Surgeons and professor of surgery at the University of Texas Medical School in Houston. “They’ve made tremendous strides in the last few years.”

But some surgeons say most current 3-D systems don’t give as sharp a picture as the best 2-D systems, and some of the headgear needed for the three-dimensional view is heavy.

Most systems use goggles with shutters that open and close over each eye 60 times a second; that can cause an annoying flickering sensation and sometimes headaches, surgeons say.

“We walked away from (making) that because of customer feedback,” said Ken Hayes, president of American Surgical Technologies Corp. of Chelmsford, Mass., which received the first FDA approval for a 3-D system.

The company sells a $45,000 system, its fourth-generation design, that Hayes says has eliminated the flickering problem and has higher resolution than most 2-D systems. He estimates that it reduces the length of an operation up to 40% by giving surgeons a more precise picture than 2-D.

“It (3-D surgery) has an undeniable benefit. It’s just a matter of degree,” said Dr. Norman B. Halpern, chief of surgical endoscopy at the University of Alabama at Birmingham.

Dr. Douglas Olsen, a Nashville, Tenn., general surgeon who helped develop the technique for laparoscopic gall bladder removal, agrees that 3-D systems aren’t needed for many uncomplicated operations.

“I have developed the ability to work in a two-dimensional world,” Olsen said. However, he notes that some surgeons aren’t switching to minimally invasive surgery because they can’t adapt to two dimensions.

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Firms Exploring 3-D Services

Medical businesses in the United States, Germany, Japan and elsewhere are rushing to develop three-dimensional imaging systems that make minimally invasive surgery quicker, easier and safer. Most are designed for general surgery, but some are highly specialized, such as one for viewing inside the fallopian tubes of infertility patients.

Among the companies in the growing field:

* Companies With FDA-Approved Systems

American Surgical Technologies Corp., Chelmsford, Mass., approved Dec. 10, 1992.

Richard Wolf Medical Instruments Corp., Vernon Hills, Ill., approved March 7, 1994.

Laser Optik Systeme, Mainz, Germany, approved April 11, 1994.

* Companies Developing 3-D Systems

Automated Medical Products Corp., New York.

Baxter International, Deerfield, Ill.

Carl Zeiss, Oberkochen, Germany.

Endo Image Corp., Odenton, Md.

Imagyn Medical Inc., Laguna Niguel, Calif.

Olympus Optical Co. Ltd., Tokyo.

Shinko Electric Industries, Tokyo.

Smith & Nephew Plc, London.

In addition, Gabriel Medical Inc., Lafayette, La., is developing an infrared imaging system for general surgery.

Sources: U.S. Food and Drug Administration, Society of Laparoendoscopic Surgeons, individual companies.