Contact us at (800) USC-CARE (800-872-2273)

A Better View

USC Norris Comprehensive Cancer Center surgeon Mike Nguyen is taking a look at the camera involved in robotic surgical procedures, to give the team a new perspective.

There’s no question that laparoscopic and robotic surgical techniques have made certain surgeries safer and better, because patients experience fewer complications, less pain and are back on their feet in less time.

One of the surgeons at USC Norris believes that he can make these procedures, which involve inserting tiny cameras into small incisions so the surgeon can see while operating, just a little bit better than they already are.

Mike Nguyen, MD, associate professor of clinical urology at the Keck School of Medicine of USC, has been conducting research on a new type of camera that he says will improve the field of vision for surgeons who perform laparoscopic and robotic surgeries.

Currently, the camera used to perform these procedures gives surgeons a three-dimensional, high-resolution image of the area where they are operating. These cameras have one major drawback, says Nguyen: Because the view is so magnified, the surgeon cannot easily see what is going on in the surrounding area.

“When you are operating on the prostate, all you can see is the prostate,” explains Nguyen, adding that surgeons need very detailed images to perform these delicate procedures. “But, in a way, you also have blinders on, because you can’t see the periphery.”

Nguyen and his colleagues at USC Urology know better than most groups of surgeons that the current technology for laparoscopic and robotic surgery could be improved, because they have collectively performed more robotic and laparoscopic procedures than most surgeons. The team at USC Urology performs hundreds of laparoscopic and robotic procedures to treat prostate, kidney and bladder cancer each year, more than any other group of urologists on the West Coast.

The camera that Nguyen is developing will provide surgeons with two views integrated into a single scope, called a multiresolution foveated laparoscope. One of the views is the high-resolution view they currently use to operate, which is highly focused on the area in question. This camera also will provide a simultaneous wide-angle view of the surrounding area, which is not available with current technology.

The second perspective view will make it possible to maintain awareness of surrounding structures, alerting surgeons if there is any bleeding that needs to be addressed in the periphery and reducing the chance of inadvertent injury, when instruments are inserted into the patient’s body. For example, when a laparoscopic scissor or other sharp instrument is inserted during surgery, it can cause an inadvertent puncture out of the view of the surgeon, because their camera remains trained on the primary surgical site.

Surgeons can — and do — check for problems around the periphery, but in order to do so with the current laparoscopes, it involves moving the instrument in and out. And while moving the camera provides the surgeon with that critical wide-angle perspective, it takes additional time and requires surgeons to shift their attention from the primary task at hand. As a result, checking the periphery is often done infrequently.

The laparoscope that Nguyen is developing also will be able to scan the area and redirect the high-resolution view to different regions of the surgical field, without moving the scope at all. This would free up space in the operating room, by eliminating the need for an assistant or robotic arm to control the camera.

The ability to show different views from one camera means that different members of the surgical team can have different views based on their role. While the surgeon may prefer a highly zoomed focused view of the primary surgical area, their surgical assistant or bedside surgical technician may prefer a wide-angle view that allows them to monitor the entire surgical field and more quickly pass instruments into the abdomen. With this new camera, team members can choose the optimal view best suited for their role, rather than compromising with a single shared view.

Nguyen, whose research is being supported by the National Institutes of Health, soon will begin testing how the multi-resolution laparoscope performs, compared to a standard laparoscope, in a series of trials. Keck Medicine of USC urologists and general surgeons will use the new technology during common surgical procedures to evaluate its benefits and limitations and further refine it for potential clinical use. “I believe that a device like this has the potential to make these surgeries even safer,” Nguyen says.

by Hope Hamashige

Keck Medicine of USC is the University of Southern California’s medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area.