Fluorescence-guided surgery has become a new standard of care for certain types of tumor resection. It involves a patient ingesting a substance prior to surgery that will metabolize and fluoresce under blue light, thus enabling the surgeon to isolate the tumor and remove it. Until recently, this type of procedure has required a microscope to help the surgeon visualize the fluorescence.
The microscope, while often referred to as the gold standard, has some disadvantages. One is that repositioning the device for different views takes time and can lengthen surgeries and therefore cause unnecessary exposure to anesthesia for the patient. Another is the cost of the microscope itself.
“The operating microscope with the fluorescent package costs about half a million dollars,” said John Walsh, corporate vice president, Designs for Vision, in an interview with MD+DI. “This restricts the availability of blue light procedures to basically academic medical centers and even within those academic medical centers, they may have one, perhaps, two of those types of microscopes,” he continued.
Designs for Vision aims to eliminate these issues with its Reveal Fluorescence Guided Surgery system. Reveal is a wearable, portable system that includes the company’s tribeam HDi headlight, which combines three high-definition imaging LEDs that allow the surgeon to decide between two excitation settings and white light. Reveal also includes a wireless Bluetooth foot pedal to control light settings, two rechargeable power packs that can be combined for a 10-hour run time, and eyewear in either 2.5x or 3.5x magnification. Enhanced visualization is achieved through emission filtering in both the magnification and eyeglass lens optics calibrated to the HDi headlight.
Reveal can be worn 18-20 in. away from the surgical field, compared with the 13 in. needed for the microscope, which means a more comfortable experience for the surgeon. Walsh received feedback from early adopters that mentioned that because Reveal is portable and doesn’t have to be repositioned for a different view, 30 to 40 minutes can sometimes be saved from procedures. The system is selling at between $7,500 and $8,500, making it much more affordable for even community-level medical centers.
In The Evolution of 5-Aminolevulinic Acid Fluorescence Visualization: Time for a Headlamp/Loupe Combination, researchers found that there was no difference between what fluoresced under a Zeiss microscope and what fluoresced under the Reveal system. “That's by far and away the best possible results for us, because you didn't want different tissues exciting,” said Walsh. “And in an interesting corollary, however, they found that Reveal would fluoresce almost 10 times brighter than the microscope, so it was easier to visualize the fluorescence.”
Walsh explained that the microscope uses beams to split the light path to cameras, monitors, or a different or separate set of oculars. “The Reveal is far simpler,” he said. “There's just the emission filter built in to the eyewear that is the only optical path that has to be transmitted through. So, it isn’t that we're providing more light or doing anything different—it’s just a simpler path.”
Designs for Vision launched Reveal in May 2021, and it is currently available in the United States, Europe, and Canada.