The Los Angeles Minimally Invasive Spine Institute Reports the First Use in the United States of a Novel Sony Heads-Up Display for Spinal Surgery

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The Sony HMS-3000MT, a unique high resolution heads-up-display for surgeons, was first used in spinal surgery in the United States on June 13, 2016. Los Angeles Minimally Invasive Spine Institute Director, Dr. George Rappard, performed a minimally invasive spine surgery using the Sony device as his “eyes” during surgery.

“With the heads-up display, any time I change my posture during a long surgery, am handed an instrument or communicate with my operating room staff my attention is on the high-resolution display of the surgical field.”

A surgical milestone was reached today in California when neurointerventional surgeon George Rappard, MD performed the first spine surgery case in the United States using a unique high resolution heads-up-display. Dr. Rappard performed a form of minimally invasive surgery called an endoscopic discectomy. In endoscopic surgery, the surgeon inserts a small tube slightly less than one third of an inch into the spine. A device called an endoscope, with a high resolution camera attached to it, is inserted through the small tube. Micro-surgical instruments are passed through the endoscope and used to perform surgery. The entire surgery is seen on a high resolution monitor, usually located several feet away from the surgeon. For the first time, the use of a high resolution heads up display allows the surgical image to be placed inches from the surgeon’s eyes, even when the surgeon turns his head slightly during surgery.

Heads-up-displays were developed predominantly for intense military applications, like fighter jet and attack helicopter pilots. These individuals require constant situational awareness, even when there gaze was shifted to attend to crucial aircraft functions. Similarly, surgeons engaged in image-guided microsurgery can benefit from the same constant attention to the displayed surgical image. “With the heads-up display, any time I change my posture during a long surgery, am handed an instrument or communicate with my operating room staff my attention is on the high-resolution display of the surgical field.” The potential benefits to the surgery are obvious; the surgeon’s gaze never leaves the surgical image leading to constant awareness during all aspects of surgery. The display makes it easier for the surgeon to detect changes during surgery since he is looking at an image inches away, instead of several feet away. The display even allows an image-on-image capability. If the surgeon requires an x-ray to check position the x-ray can be projected on the heads-up-display, along with the view of surgery. Therefore, the surgeon does not have to shift between multiple monitors. Ergonomically, the viewing helmet is designed so that the surgical image is projected at a 45 degree angle from the surgeon’s eye, thus reproducing a natural viewing angle. The image is projected on each of 2 separate panels, one for each eye. The panels are adjusted to provide natural binocular vision. Lastly, the heads up display allows the surgeon to shift his posture during surgery while maintaining his view. This is key as it reduces surgeon fatigue and maintains the surgeon’s focus. Dr. Rappard noted a surprisingly new level of comfort using the heads-up display despite a 3 hour surgery.

The advent of a high resolution heads-up display is just the latest in a series of surgical innovations that allow surgeons like Rappard to treat patients in ways never before imagined. Together with high resolution cameras, modern endoscopes and precisely engineered micro-instruments, these displays allow modern surgeons to bring new technologies to bear in order to provide new procedures that make surgery easier for patients than ever before. Many of these procedures have been developed by innovative and creative surgeons that Rappard credits as his mentors. Rappard pays homage to these innovative neurointerventional and endoscopic surgeons by quoting a reporter named Mary O’Keefe: “The key to medical advancement is not only the invention and discovery of new methods but also the skilled physician who is willing to learn and enter the latest frontiers of medicine.”

The Los Angeles Minimally Invasive Spine Institute was founded in 2012. The mission of the Institute is to provide the most comprehensive quality minimally invasive spine care available, to use knowledge and experience to teach spine health care providers, to further spinal scientific research and to advocate for patients on the national and international arenas. Rappard is the director and founder of the Los Angeles Minimally Invasive Spine Institute, the director of the Brain and Spine Research Institute, an Adjunct Professor of the Southern California University of Health Sciences and a member of multiple scientific and medical committees of national and international spine health organizations.

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Evelyn Gonzalez
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George Rappard, MD NeuroInterventional Surgeon
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