Video Assisted Carotid Endarterectomy (VACE): Will This Replace The Surgical Loupes?
Cassra Arbabi, MD, Marc Arizmendez, George Berci, MD, Ali Azizzadeh, MD.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Introduction: The use of surgical loupes during open vascular surgery has been a common practice for decades. However, the limited depth of field, narrow field of vision, fixed magnification, and poor ergonomics are limitations that come with the use of loupes. We studied the intraoperative use of a high-definition (HD) compact video microscope (VITOM®; Karl Storz Endoscopy) to improve these limitations.
Methods: The VITOM scope was used during a right carotid endarterectomy (CEA). The scope was mounted over the contralateral shoulder of the patient and the camera placed at 40cm above the surgical field. Two HD monitors were placed on each side of operating table at eye level. The team included the attending surgeon, assisting resident, medical student, scrub tech and circulator. A CEA was performed in standard fashion. Post-operatively, the team completed a survey that included an assessment of visualization, depth of field, field of vision, degree of spinal strain, fatigue and an overall experience rating.
Results: A 71-year-old male presented with syncope. Cardiac workup revealed multivessel coronary artery disease, with plans for coronary artery bypass grafting (CABG). Initial carotid duplex showed a right internal carotid artery (ICA) occlusion, however CT angiography revealed a 99% stenosis with “string sign”. A follow up cerebral angiogram confirmed a high-grade stenosis. A right VACE was performed without complication. The results of the post-operative survey revealed an overall positive experience from the entire surgical team. The surgeons reported an improvement in visualization with an expanded depth of field and field of vision. The degree of neck strain and spinal discomfort was reduced, leading to a decrease in postural fatigue. The remaining team members reported an enhanced visualization of the operative field via the HD monitors, allowing them to follow the operation step-by-step and to remain engaged throughout the case.
Conclusion: Our experience demonstrates the feasibility and benefits of VACE, including an enhanced field of vision and depth of field, while reducing spinal strain and fatigue. VACE also allows the entire surgical team to visualize the operative field and be involved in the flow of the operation. Finally, the HD video recordings provide an educational platform that can be used for training purposes. Larger studies are required to further assess the potential benefits of this technology.
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