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Victor Maccharoli- True Vision Systems VP of Marketing Robert Reali explains how the new 3D system for microscopes would work during a medical procedure.

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The future of surgery is here

By ERIC LINDBERG — March 11, 2009

In a nondescript building on East Haley Street, a group of doctors, scientists and computer programmers are helping people see.

Their technology is the latest and greatest in the field of eye surgery — three-dimensional projections designed to give doctors a better view and guidance as they operate.

The company is fittingly named TrueVision Systems, Inc., and its leaders can’t contain their excitement about the technology currently being developed and refined in Santa Barbara.

“We’re breaking new ground,” said CEO Forrest Fleming. “We’re Lewis and Clark here.”

In a nutshell, the technology allows surgeons to don 3-D glasses and watch a high-quality camera feed on a 40-inch projection screen as they operate, instead of using a standard surgical microscope.

There are several benefits to that approach, said Robert Reali, the company’s vice president of marketing. First, nurses and other doctors can follow along as the surgeon operates.

“It definitely changes the dynamic in the operating room for the better,” he said.

Dr. Douglas Katsev, an ophthalmologist and cornea specialist at Sansum Clinic, has been using the system for several years and couldn’t agree more.

“It becomes like a real surgical case where everybody in the [operating room] is on the same page,” he said. “They’re going to recognize a problem and see I’m going to alter what I’m going to do right when it happens.”

For example, he said, nurses might anticipate what surgical instrument he will request next and be ready with it before he even asks.

Another benefit is merely physical — surgeons won’t have to remain hunched over a surgical microscope as they operate.

“Ergonomically, it’s far superior,” Dr. Katsev said, explaining that a typical workload for him is 25 patients a day. “You get pretty tired hunched over the same way.”

The system also offers the ability to record the operation in 3-D, allowing doctors to use the footage for educational purposes.

While the technology has already been used for spinal and brain surgery, the company is focused on eyesight at the moment because cataract surgery is the most common operation in the world.

And of the 14 million people who have a cataract operation annually, 60 percent also have other trouble with their eyesight, such as astigmatism, Fleming said.

He hopes to capitalize on that fact with another application of the TrueVision system that is still in the works.

Programmers are currently developing software that will essentially serve as a guidance system for surgeons, showing them precisely where to make incisions for a variety of operations.

So after doctors remove a cataract, Fleming said they will be able to punch up a new set of directions that will guide them as they adjust the cornea to fix other eyesight problems.

“The real goal is perfect vision coming out of cataract surgery,” Fleming said.

Once the guidance system is complete, surgeons will be able to take a scan of a patient’s eye prior to surgery. During the operation, the program will then display lines on the 3-D screen showing the surgeon where and how incisions should be made.

“People are trying to do it today and, believe it or not, they’re using a Sharpie to mark the eye,” Fleming said.

That aspect of the TrueVision system should go into clinical trials this summer. Dr. Katsev said it will be a welcome component to the visualization system, particularly for new doctors.

“It’s a tool set that will make cataract surgery more accurate,” he said. “Almost like a coloring book, you can just follow the lines.”

Fleming and Reali see the TrueVision program as a platform for other technologies, much like a computer operating system allows for an endless amount of applications and programs.

One of those technologies could make surgery even more accurate, Fleming said, by using lasers to make incisions based on the guidance system, rather than relying on a surgeon’s hand.

“It sort of takes away the Michelangelo surgeon, the surgeon who is more art than science,” he said. “…This is a game-changer for microsurgery.”

While those advancements are still years away, the company’s leaders see their technology as a path to providing a consistent and improved standard of care.

“That is the goal of the company, to lead to better outcomes,” Reali said.

Founded in 2003, TrueVision Systems launched its first round of sales last year and made approximately $700,000. Reali said he expects the company to break the million-dollar mark this year.

Meanwhile, programmers and scientists at the company are already working on the next generation of the system, which would utilize a 46-inch flat panel monitor rather than the somewhat bulky projection equipment.

“It’s just a matter of time,” Dr. Katsev said of the technological curve. “I think it will be the standard thing that people do.”

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