Binocular Surgical Microscope

$6,529.00

  • A simple binocular coaxial illumination surgery microscope with a compact design and high flexibility to meet the requirements of general animal microsurgery.
  • Eyepieces: 12.5X focus length of objective: 200mm
  • Working distance: 190mm Total magnification: 5.3X, 8X, 12X
  • Visual field(mm): 38mm, 25mm, 17mm
  • Diopter adjustment range: +5D
  • Pupil distance range: 50mm~70mm
  • Bulb: 12V/100W (Medical halogen lamp Bulb with cold reflection)
  • Type of Illumination: 6°+ 0°cold light source coaxial illumination
  • Intensity of Illumination: 20000Lx or up
  • Maximum stretching radius of arm: 870mm
  • Vertical movement range (from floor to front surface of the objective): 700mm~1100mm
  • Range of fine focusing adjustment: 30mm
  • Input voltage: AC220V±10%, 50Hz±1Hz Input power: 120VA
  • Power: AC250V T1.25A Net weight: 41kg
SKU: RWD-77002 Categories: ,

Introduction

An operating or surgical binocular microscope is an optical device that presents the surgeon with a stereoscopic vision, and a high quality magnified and illuminated the image of the minute structures in the surgical region. The surgical microscope is usually used to perform microsurgery. s. Primarily a radical idea, the operating microscope has turned into a necessary tool since the first known usage of the binocular microscope during surgery. Its powerful stereoscopic magnification and illumination of the operative bed prompted its quick acceptance by numerous surgeons all over the world.

The introduction of the surgical microscope in the operating room opened a new chapter in the history of microsurgery. It extended the limits of the field, enhanced patient outcomes and made the development of subspecialties possible. It granted access to regions of the brain and spinal cord that were previously thought to be impossible to reach. The increased magnification allowed for smaller incisions, enhanced visibility and dissection of sensitive tissues. It provided sufficient hemostasis when working through constricted and deep surgical sites and also frequently helped to cut down the time period of the surgery and decrease anesthetic dangers. On the whole, the binocular surgical microscope has been extensively used in the fields of neurosurgery, plastic surgery, dentistry (particularly endodontics), ENT surgical procedures, and ophthalmic surgeries.

Ever since the surgical microscope has been introduced into the operating room, various factors like the size, focus, and flexibility of the microscope have proved to be challenging, and solutions have frequently led to new issues. According to an estimate, the majority of surgeons may spend around 40% of their total time during surgery to make adjustments to the surgical microscope. Focusing is normally manual, even though some more advanced microscopes have an autofocus aspect included. The advanced technology of surgical instrument tracking autofocus will have the capacity to extensively reduce the surgical duration and furthermore enhance the efficiency of the surgeon.

In general, a surgical microscope may cost a few thousand dollars for a basic model, whereas highly developed models might be significantly more costly. Additionally, specialized microsurgical tools might be needed to take full advantage of the enhanced vision the microscope provides. It may take time to ace the operational aspect of the surgical microscope. However, the surgical microscope is unmistakably superior to the customary surgical loupes that require high magnification and adjustable focus. Even so, the complex mobility and the elevated cost of the surgical microscope have given rise to the necessity for more transportable solutions. A head-mounted operating microscope was lately launched in the market. It brings together the portability of the surgical loupes and the magnification and focusing capacity of a microscope.

A fundamental feature of any surgical microscope is its design.  The device is designed in such a manner that the surgeon concentrates fully on the surgical procedure while remaining comfortable and free of eye strain. The design of the microscope likewise frees the surgeon’s hands to operate. Most of the microsurgical operations take place in a small space or through narrow gaps and in these cases, it is imperative to the surgeon that he retains a sufficiently well-lit binocular vision in the recesses of the area. In such circumstances, the stereoscopic perspective provided by the binocular surgical microscope is the most valuable feature of the device.

The binocular surgical microscope serves two major functions: magnification of the operative field and illumination. With the assistance of a foot or hand switch, it can enlarge structures up to 40+ times. Along with increased magnification, an inbuilt halogen or Xenon lamp gives outstanding lighting right above the surgical area. Advanced microscopes can self-adjust the strength of the illumination to avoid tissue damage, as the microscope shifts nearer or further away from the operative field. Additionally, the surgical microscope has three oculars. One of the oculars is positioned on the side; it tends to fit on either side of the central oculars. The adjustments may affect the stability of the microscope, and the device requires balance prior to its usage. Auto-balance features are as easy as the push of a button and have the capacity to re-balance the microscope securely during the process.

The binocular surgical microscope is comprised of numerous joints to allow for 180° movement, including adjustments for the various seating positions of the patient. The commercial surgical microscopes are mainly positioned on a wheelbase.  They can be placed inside the operating room or shifted from one room then onto the next. The modern surgical microscopes are equipped with cameras that can capture high-resolution images or record high-quality videos. These pictures and video recordings can be stored in integrated or external hard drives or memory sticks, or even transferred onto DVD and Blu-ray discs.

Principles

The magnification of an image is a dependent value and depends on the size of an image as projected on top of the retina of the eye. Consequently, the magnification of a picture is increased by merely reducing the distance between the eye and the object. When the object in question draws nearer to the observing eye, the size of the projected image on the retina is increased.  If the retinal region covered by the projected image is doubled, then the magnification would be observed as 2x or two times larger than what it was before, taking the preceding position as a base value. With the utilization of the binocular microscope, and without altering the distance value, the size of the reflected image of an item can be increased on the retina. The amount of increase, at that point, turns into the magnification value of the specific binocular microscope, for example, a 7x binocular has a predetermined estimate of increasing by seven-fold.

The light that the surgical microscope illuminator transmits to enlighten the surgical site can be varied. One method to change the light is to vary the voltage to the light bulb. The majority of the microscope floor stand power supplies have a prerequisite to change the strength of the light by this technique. Below the microscope, a particular amount of light will be transmitted, and any adjustment made in the magnification of the microscope will have no impact on the amount of light being transmitted from the microscope. However, variations made in the magnification of the microscope do enhance or reduce the amount of light which will be transmitted back through the microscope and on top of the retina of the eye of the observer.

Furthermore, the surgical microscope is capable of providing stereoscopic vision in confined spaces by decreasing the required interpupillary distance needed for binocular vision. The distance between the frontal lenses of the binocular tube of the microscope is just 16 mm, while the standard interpupillary distance is around 60 mm. This implies that light reflected from deep basal structures towards the surgical microscope during an operation utilizing fissure, sulci or transcortical methods, will lead to a stereoscopic image when only a 16mm image penetrates the eye through a microscope. Conversely, if the surgeon is assisted with magnification loupes in place of the surgical microscope, the eyes will not be able to retain stereoscopic vision in such a constricted area

History

Origin

The first use of a microscope in the operating room was initiated by the Swedish Carl Nylen in 1922 when Nylen chose to utilize a monocular Brinell-Leitz microscope, rather than a loupe, for performing surgery on a patient with chronic otitis media with labyrinthine fistulas. However, monocular microscopes did not offer depth perception, and the lack of a light source in the initial designs led to the dimness of the image as the magnification increased. In 1922, Gunnar Holmgren utilized a binocular microscope to overcome the absence of depth perception and additionally, connected a light source to the microscope to resolve the latter setback. This led to a new era in the advancement of numerous microsurgical specialties, for example, neurosurgery, ENT, ophthalmology and plastic surgery (Uluç, Kujoth, & Başkaya, 2009).

Development

In 1948, Richard A. Perritt began to use an adaptation of the Bausch & Lomb slit-lamp microscope which was hanging from a weighted table stand along with its coaxial lighting unit and variable magnification. In 1952, Hans Littmann, a physicist at Zeiss, began a new era by developing a microscope which was capable of altering magnification without altering focal length. Horst L. Wullstein, an otolaryngology surgeon, constructed a microscope built on a stand provided with a rotating arm. In 1953, Littmann profited from Wullstein’s design and knowledge and produced the “Zeiss OPMI 1” (Zeiss Operating Microscope 1), which was increasingly stable, easy to operate, and had better coaxial lighting than any other commercially available operating microscope. During that same year, Heinrich Harms and Günter Mackensen modified this microscope for use in ophthalmological treatment during middle ear surgery. The operating microscope was further integrated into the field of neurosurgery by Theodore Kurze in 1957. From 1958 to 1970, the operating microscope underwent several modifications and was equipped with customized stands, motorized zoom objective, short ocular tubes and a slit lamp, film, TV camera, and other sources of illumination. Zeiss designed the OPMI CS in 1991 and the OPMI ES in 1994, particularly made for neurosurgery. In 1997, Zeiss introduced the OPMI Neuro and later provided this microscope with Multivision system which projects superior imaging techniques (for instance, MR imaging, CT, etc) directly into the eyepieces (Uluç, Kujoth, & Başkaya, 2009).

Apparatus And Equipment

The modern binocular surgical microscope has a compact design and high flexibility and may be mounted on a stand, or set on a table top. The basic surgical microscope framework typically consists of a binocular head with adjustable eyepieces, an illumination module, a fiber optic cable, locking clamp, and foot controls. The microscope itself consists of the objective lens, diopter lock button, diopter ring, magnification changer, and maneuvering handle.

The binocular head along with the eyepieces is basic, but it is also possible to attach a separate head for an associate which is called a teaching head. The binocular head may rotate separately and have its own magnification levels. The foot controls are used for tilting, focusing, and zooming during the surgical procedure. The illuminator provides incandescent, fiber optic and halogen illumination.  The objective lens of the surgical microscope has a variable focal length which is dependent on the depth of the operative field enabling the microscope to be adjusted at different distances. The magnification is usually set in three to six presets varying from 6X – 25X. The magnification changer is a lens system positioned between the objective lens and the binocular system and enables constant adjustment of magnification.

Specifications

Eyepieces12.5X focus length of objective: 200mm
Working distance190mm
Total magnification5.3X, 8X, 12X
Most of the microsurgical operations take place in a small space or through narrow gaps and in these cases it is imperative to the surgeon that he retains a sufficiently welllit binocular vision in the recesses of the area. In such circumstances, the stereoscopic perspective provided by the binocular surgical microscope is the most valuable feature of the device.
Diopter adjustment range+5D
Pupil distance range50mm~70mm
Bulb12V/100W (Medical halogen lamp Bulb with cold reflection)
Type of Illumination6°+ 0°cold light source coaxial illumination
Intensity of Illumination20000Lx or up
Maximum stretching radius of the arm870mm
Vertical movement range (from floor to front surface of the objective)700mm~1100mm
Range of fine focusing adjustment30mm
Input voltageAC220V±10%, 50Hz±1Hz
Input power120VA
PowerAC250V T1.25A
Net weight41kg

Training Protocol

The basic aim of the surgical microscope is to improve the visual perspective of the surgeon through magnification, illumination, and resolution.

  • First, complete the installation of the device and shift the surgical microscope to an appropriate location for the surgery and bolt the castors.
  • Adjust the counter-balanced arm and the main microscope to a convenient position and screw the corresponding lock shut.
  • Next, hold the main surgical microscope with the hand and release the up-down positioning knob and rotate the balance knob until the main microscope has free up and down movement.
  • Then, switch on the power button, turn the brightness switch on and loosen the corresponding lock to move the device.
  • Pull the main microscope over the surgical field within the height of the working distance (which relies upon the focal length of the objective lens), until the images can be viewed in the binoculars and tighten the corresponding lock.
  • Adjust the position of the binocular by hand to achieve the appropriate papillary distance.
  • Next, rotate the magnification changer knob to achieve the required magnification level.
  • Adjust the illuminator module to achieve the required illumination on the surgical site and get the best clear visual image by the motorized up-down focus method or activate the focus function on the foot control.
  • After adjusting the focus, check if the two eyes have varying diopters and alter the diopter on the eyepiece for each eye.
  • Use the back-forth inclination function by rotating the inclination knob by back and forth and positioning the main microscope at a proper place.
  • In the same manner, adjust the right and left inclination adjustment and bring the microscope at an appropriate position.
  • After the procedure is over and the surgical microscope is not in use, switch the bright switch off and after a few minutes turn off the power switch of the unit.
  • Release the corresponding lock and move the arm and main microscope to a suitable spot and wrap it with a plastic-proof cover.

Applications In Surgical Experiments

Laboratory animals have played a central role in the development of modern-day microsurgical methods which are currently utilized routinely in numerous clinical divisions around the world. Consequently, microsurgical methods are imperative in biomedical research as they enable numerous surgeries to be performed on rodents rather than dogs, pigs or primates. This has obvious benefits such as low cost, the utilization of statistically authentic numbers for examination and the availability of genetically defined laboratory animals which is likely to provide authentic solutions to immunological answers. Furthermore, performing surgeries on animals allows the surgeon to obtain experience and practice in micro-techniques, and to conduct surgical experiments (Green, 1987).

Good visualization during rodent surgery by integrating magnification and illumination plays a vital role in surgical outcomes; however, there is little consensus in regards to its execution. Ever since the surgeons started to utilize the surgical microscope and have been at ease while using it, they have come to the conclusion that working without the advantage of magnification is insufficient. The dawn of microscopy in rodent surgery has increased opportunities for surgeons and has considerably enhanced the quality of surgical procedures. Utilizing microsurgical methods has proved that it is possible to transplant kidney, heart, liver, lung, ovary, oviduct, pancreas, spleen, small bowel, stomach, testicles, whole joints as well as the growth plate, peripheral nerve and free vascularized skin flaps in rodents and rabbits.

The surgical microscope was initially utilized experimentally in 1921 while working on labyrinthine fistulae and performing fenestrations in rabbits at a magnification of 10 – 15 times. The progress of microsurgical methods has ever since then heavily relied on experimental animals and has been driven by the needs of clinical surgeries for more refined methods and by the requirement for novel lab models in biomedical research. The information that these experiments have yielded propose yet more clinical possibilities which thus create yet more questions and so forth. Out of that initial work of Nylen, an entirely new range of surgeries was created for the middle ear, acknowledged just gradually at first, however, then in the mid-1950s moving ahead quickly to the highly refined strategies normally utilized in otolaryngology today. In 1946, Perrit started to utilize the surgical microscope for routine ophthalmic surgeries. It was later utilized for new procedures in the anterior and posterior segments of the eyeball where, for instance, improved methods of corneal grafting were developed at first in rabbits.

It was not until the early 1960s, however, that the vast potential of using the surgical microscope to perform microsurgeries was acknowledged in other surgical disciplines. The successful, ground-breaking experiments of Jacobsen and Saurez (1960) on rodents exhibited that small veins less than 1.0 mm in diameter could be connected (anastomosed) utilizing microvascular strategies which they created. A few other surgeons later transplanted kidneys in rodents and anastomosed divided oviducts in rabbits and ureters and vas deferens in canines. These strategies were then administered to plastic and reconstructive operating procedures, to peripheral surgeries and to experimental organ transplantation.

Neurosurgeons utilized the binocular surgical microscope for dissections deep inside the cranial vault and to analyze and operate aneurysms and tumors with minor disturbance to the basic cerebral blood supply. Additionally, gynecologists grew interested in the microsurgical reconstruction of the female genital tract for treating infertility after an experimental procedure in rabbits demonstrated that the transected oviduct could be anastomosed with high outcome pregnancy rate. In the same way, urologists become interested in using the surgical microscope to perform microsurgery as a means of reversing vasectomies in males after methods had been developed in animals for repairing various structures in the urogenital tract.

Maintenance And Precautions

The binocular surgical microscope is a high-grade technological instrument that requires regular maintenance.

  • The objective lenses, eyepieces, and accessories which are not being utilized must always be kept in dust-free containers.
  • The external surfaces of optical parts like eyepieces and objective lenses only need to be cleaned when necessary without utilizing any chemical cleaning agent.
  • The dust on the surface of optical components may be blown off by utilizing a squeeze blower, or it can be eliminated by utilizing a clean grease-free brush.
  • Use an anti-fogging agent to protect the eyepiece optics from fogging.
  • All mechanical surfaces of the instrument can be simply cleaned with a damp cloth without the use of aggressive agents.
  • Wrap the foot pedal with a clear plastic cover to avoid damage to the electronics from surgical and cleaning fluids.
  • Abstain from looking directly into the light source, e.g., into the objective lens or a light guide.
  • Do not run the instrument in locations at risk of explosives or containing inflammable anesthetics or volatile chemicals.
  • Do not place or utilize the equipment in damp rooms and avoid exposing the instrument to water.
  • Promptly unplug any instrument that emits smoke, sparks or odd sounds.

Strengths

The binocular surgical microscope is a high-grade technological instrument that requires regular maintenance.

  • The objective lenses, eyepieces, and accessories which are not being utilized must always be kept in dust-free containers.
  • The external surfaces of optical parts like eyepieces and objective lenses only need to be cleaned when necessary without utilizing any chemical cleaning agent.
  • The dust on the surface of optical components may be blown off by utilizing a squeeze blower, or it can be eliminated by utilizing a clean grease-free brush.
  • Use an anti-fogging agent to protect the eyepiece optics from fogging.
  • All mechanical surfaces of the instrument can be simply cleaned with a damp cloth without the use of aggressive agents.
  • Wrap the foot pedal with a clear plastic cover to avoid damage to the electronics from surgical and cleaning fluids.
  • Abstain from looking directly into the light source, e.g., into the objective lens or a light guide.
  • Do not run the instrument in locations at risk of explosives or containing inflammable anesthetics or volatile chemicals.
  • Do not place or utilize the equipment in damp rooms and avoid exposing the instrument to water.
  • Promptly unplug any instrument that emits smoke, sparks or odd sounds.

Limitations

The binocular surgical microscope has its own set of limitations. The instrument itself can prove to be bulky and occupies a lot of room in the operating room and is quite difficult to transfer to another room. The device may sometimes restrict the position of the surgeon as it limits the operation field and may thus increase the surgical duration. In case the visual area is restricted, the surgeon might need to frequently reposition the microscope to reduce the issue of blind spots and obscured areas.  In addition, training with respect to its components and utilization is an absolute necessity before performing surgery, and the learning curve is noticeably higher.

Another limitation of the surgical microscope is that as the magnification increases, the field of view and depth of focus decreases. The magnifying lenses may also become foggy during the surgical procedure. In addition, a lot of time is required before the user can become accustomed to using the microscope.  Toward the start of utilizing a surgical microscope, inexperienced surgeons frequently experience issues with hand-eye coordination. The microscope also requires proper and constant maintenance and may turn out to be expensive.

Summary

  • The binocular surgical microscope improves the surgeon’s view through providing great magnification, powerful illumination, and a stereoscopic perspective during surgery.
  • The basic surgical microscope typically consists of a binocular head, adjustable eyepieces, illumination, foot controls, objective lens, diopter lock button, diopter ring, and magnification changer.
  • The device is used in various surgical disciplines such as microvascular surgery, plastic and reconstructive surgery, neurosurgery, otorhinolaryngology, transplantation procedures, oncology, urology, and dentistry, etc.
  • The binocular surgical microscope eliminates the problems that arise from standing for long durations during conventional surgeries such as fatigue, neck pain, eye strain, and posture-related problems.
  • The device can be rather bulky and take up a lot of space as well as require proper and constant maintenance.

References

Cordero, I. (2014). Understanding and caring for an operating microscopeCommunity Eye Health, 27(85), 17.

Girman, P., Kriz, J., & Balaz, P. (2015). Rat Experimental Transplantation Surgery. Switzerland: Springer International.

Green, C. J. (1987). Microsurgery in the clinic and laboratoryLaboratory Animals, 21(1), 1-10. doi: 10.1258/002367787780740734

Jabbour, P. M. (2013). Neurovascular Surgical Techniques. New Delhi: Japyee Brothers Medical Publishers.

Kamath, D., Paul, J., Joseph, A., & Varghese, J. (2015). Magnification in Endodontics. J Odontol Res, 3(1), 31-34. doi: 10.18231/2456-8953.2018.0001

Siemionow, M. Z. (2015). Plastic and Reconstructive Surgery. London: Springer.

Uluç, K., Kujoth, G. C. & Başkaya. M. K. (2009). Operating microscopes: past, present, and future. Neurosurg Focus, 27(3), E4. doi:10.3171/2009.6.FOCUS09120.

Yasargil, M. G. (1969). Microsurgery: Applied to Neurosurgery. New York: Academic Press.

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