Night Vision in Open Surgery: Dark Operating Rooms Could Improve VR Immersion

By José Luis Mosso et al.

Studies now support that Virtual Reality (VR) immersion can act as an effective tool to distract a patient during painful medical procedures. Further research is being conducted to explore ways in which virtual environments and resulting feelings of presence can be made more realistic. This study explores the use of night vision technology to perform open surgery on rabbits. This could make ambulatory surgery on humans possible in a setting of total immersion, with the intent to reduce pain and anxiety while patients navigate virtual scenarios and surgeons perform surgeries in total darkness with the ability to control light.

Physicians make diagnoses everyday employing methods dating since the last century that use fixed black and white or color images, like X-Ray images or pictures showing motion, like sonographs. There is also sophisticated equipment used to perform invasive procedures like vascular exploratory examinations with a catheter, or liquid extraction from amniotic fluid with sonographs, a method used in obstetrics. In battle settings, soldiers use night vision with green, black and white colors to identify military targets. The equipment they use is mounted on casks, enabling a panoramic view.

In 2009, at the Department of Surgery at the Panamericana University, Mexico City, we conducted a study to integrate these two practices using a wireless microcamera with infrared light mounted on the head of a surgeon, and night vision infrared stealth goggles for the first assistant. These goggles were used throughout the operation.

It was possible to perform eight surgeries on rabbits without surgical complications. Surgeries performed included one laparotomy, one appendectomy, three nephrectomies, one splenectomy, one left thoracotomy, and one right thoracotomy, which were done under general anesthesia. The surgical and anesthesia techniques didn’t change in this project, but all lights in the operating room were turned off. The surgeon and first assistant had the ability to see the surgical field in total darkness. Technical limitations included difficulties such as a short distance between the microcamera, located on the surgeon’s head, and the power source. The short length of the cables limited the surgeon’s movement, but the limitation was easily resolved. It was possible to recognize large surgical tools in black and white, such as scissors, graspers, needle holder, and retractors. However, the catgut cromic 00 suture was difficult to grasp because it is clear or transparent. It also became apparent that it is easier to recognize veins than arteries in darkness. We included a control group using traditional techniques, with the lights turned on. Surgical times were similar, with a slight delay during the surgeries performed in total darkness. The two rabbits used in this project were euthanized after the surgeries.

Open surgeries performed on rabbits with the aid of night vision technology showed promising results. In future works, it is necessary to improve the resolution of microcameras and all participants in the operating room must use the same equipment. Future surgical procedures which could be performed on humans using this technique include non-complicated hernia repairs, large lipomas in soft tissue, subclavian catheter insertions and leg amputations. This technology could be improved with technology such as augmented reality and 3-D vision. Cybertherapy could thus be used during surgical applications to allow patients to be immersed in total darkness during surgery, making VR immersion more realistic.

José Luis Mosso, M.D.                                                                                                  Ojeda Roberto Gonzalez, Ph.D.                                                                                     Rosas Gerardo Arrel lin, M.D.                                                                                   Elizabeth Rodriguez Schlogl                                                                                     Dejanira Mosso Lara                                                                                         Panamericana University                                                                                           Mexico

MAJ Melba C. Stetz, Ph.D.                                                                                             Tripler Army Medical Center                                                                                       U.S.A.                                                                                                               quele01@yahoo.com