Operative Microscope In-Field Visualization of Confocal Laser Endomicroscopy Interface (Zeiss CONVIVO®)

Using confocal endomicroscopy (CLE) in neurosurgery holds the potential for intraoperative diagnosis and correct identification of tumor margins. Still, the correct employment of such a promising technique requires either an external dedicated person to interact with the neurosurgeon during the operation to check the quality of the acquired images or the operator to look directly and frequently outside of the operative field while maintaining the confocal microscopy probe in the surgical cave, thus interrupting the surgical flow, potentially disturbing the correct execution of surgical maneuvers and hindering a correct image acquisition.

To overcome this problem, we integrated the confocal microscopy interface (Zeiss CONVIVO®) into the surgical view through the operative microscope (Heads-up display). We enrolled patients undergoing surgery with the use of CLE for different pathologies, and we randomly allocated them to be operated with the heads-up display integration or without it. The mean CLE employment time and the number of usable and nonusable captures were annotated.

Twenty-two patients were enrolled of which 12 patients underwent the procedure without the heads-up integration (54.5%) and 10 (45.5%) with it. The mean usage time of the CONVIVO® was 137 (±134) seconds, 61.1 (±38) seconds for the heads-up display group, and 201.6 (±154.1) seconds for the non-heads-up display group ( P = .01). The heads-up display group showed a higher proportion of usable images (11 [±4] vs 50 [±37], 21.7%) than the non-heads-up display group (30 [±21] vs 163 [±33], 18.4%), although nonsignificant ( P = .06). A significant influence of the intraoperative visualization on overall employment of CLE and a reduced number of images collected (611 vs 2139; P = .007).

By allowing the operator to check the quality of the images directly while still looking inside the operating field, better-quality images and a reduced number of unemployable captures are obtained, resulting in more efficient and less time-consuming use of intraoperative confocal microscopy, ultimately leading to reduced operative length.