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Endoscopic vision
Endoscopic surgery consists in using an endoscope
within a natural or artificial body cavity. Conventional
microsurgery, which uses an exoscope, does not allow
endoscopic vision. The 3D camera of the DaVinci robot
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can be used either as an exoscope or as an endoscope in
order to practice open or endoscopic telemicrosurgery.
Augmented vision
Augmented reality consists in representing virtual data
on a real image. Since the invention of this concept by
Thomas Caudell in the early 1990s, augmented reality
has been applied to many areas. In medicine, it naturally
found technical applications using an optical devices
and/or a camera: laparoscopy, arthroscopy, endoscopy,
[2]
Figure 2: Intrathoracic view of three intercostal nerves in a pig harvested and microsurgery. Among all fields of use, the purpose
with the DaVinci robot during a telemicrosurgical intervention of augmented reality is to simplify and to accelerate
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access to complex data by combining the elements of
it allows magnification of vision up to 25 times thanks the operating field of the surgeon. Augmented reality can
to a digital zoom. Although the current magnification of be applied to conventional microsurgery, but indications
the DaVinci robot is lower than that of conventional remain limited due to the impossibility to use endoscopy
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microscopes, it is not a limiting factor to its use in because a conventional microscope remains an exoscope
conventional microsurgery, but it is not feasible in and does not allow internal vision. Considering the
supermicrosurgery. Considering the prospects, a specific prospects, endoscopic telemicrosurgery of the brachial
robot to telemicrosurgery shall improve its optical plexus could evolve. From an internal view of a cavity,
magnification capacity. the anatomical structures of the brachial plexus and
their relationship with other structures including vascular
Three‑dimensional vision tissues can be difficult to identify. The registration in real
3D vision is required in microsurgery because the depth of time by magnetic resonance angiography images with
the operating field is less than 1 cm. 2D vision does not direct intraoperative vision could act as a true anatomical
allow to assess acutely the position of anatomical structures global positioning system.
and instruments into space, and can lead to tissue damage.
Conventional microsurgery and telemicrosurgery allow 3D Manual tremor filtration
vision, a shifted image arriving to each eye in both cases, Physiological tremor in microsurgery is detrimental and
by an optical lens or CCD camera. Considering perspectives, unfavorable in supermicrosurgery. Telemicrosurgery makes
one can mention the extreme miniaturization of cameras it vanish through an interface filter, which not only
and obtaining a 3D vision with a single camera with improves the comfort of the surgeon, but it can also be
methods of real‑time image processing. suggestive of facilitating supermicrosurgery.
Functionalized vision Magnification of the manual movement
Vision through a conventional microscope is an external The scaling of hand movement is a fundamental property
magnified vision. Various tools make it possible to see in microsurgery because it increases the precision of
beyond the mere external appearance, revealing functional the operator’s movement. It will become indispensable
properties. Some systems enable to form an additional in supermicrosurgery, as for example in lymphatic
[1]
image that reveals microcirculation and therefore make vessels. In the old S version of DaVinci robot, the scale
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it easier to distinguish cancerous tissue from healthy reached 1/5. On the newer SI versions of the DaVinci
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tissue by the injection of a small amount of indocyanine robot, the scale is reduced to 1/3. The reason is that the
green, a dye tracer visualized by an infrared system. This current market is focused on telesurgery and urological
noninvasive technique also verifies the effectiveness of a laparoscopic surgery, which do not require a greater
vascular anastomosis. The micro‑Doppler allows to study scaling. Considering the prospects, the development
the permeability of a vascular suture by transforming of a specific robot to telemicrosurgery should increase
visual information of arterial or venous flow into the scale of the movement up to 1/10 or even more for
an audible sound to the naked ear. Considering the supermicrosurgery.
prospects, some micro‑ultrasound systems could allow
to study microvascularization, but also the internal Magnification of manual movement amplitudes
structure of peripheral nerves. This could be very useful Movements of the upper extremity and hand have limited
to determine precisely the exact level of nerve transaction average amplitudes due to their anatomy. For example,
before performing a nerve graft of the brachial plexus the normal range of motion of supination averages 180°.
for example, with respect to the method currently It is therefore not possible in microsurgery to make
used (simple manual palpation of the nerve in order to a movement of more than 180° without dropping the
perceive an internal loss of substance). instrument. The DaVinci robot allows pronosupination up
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222 Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015