Utilizing Viseon Camera for Minimally Invasive Lumbar Decompression Surgery in Low and Middle-Income Countries: A Technique and Feasibility Study.

Abstract

Introduction:
Minimally invasive spinal surgery (MISS) offers better outcomes and quality of life than traditional methods. However, MISS is yet to be adopted in low-and middle-income countries (LMICs) owing to limited knowledge and resources, such as a lack of access to endoscopes or microscopes, which are cumbersome, expensive, and require specific maintenance.

Objective:
We aim to describe our initial experience utilizing the Viseon MaxView camera system for MISS at Muhimbili Orthopedic Institute, highlighting this system's safety, feasibility, and applicability.

Method:
We report four cases of tubular over-the-top lumbar decompression using the Viseon Max camera system in a resource-constrained setting. The Viseon MaxView System is a novel visualization system that utilizes a miniature, single-use camera attached to a tubular retractor and projects 4K resolution images onto a head-up display. Data on the surgery duration, blood loss, perioperative complication, and technique mishap were collected. Short-term clinical outcome was also assessed using the visual analog scale (VAS) and the Oswestry disability index (ODI).

Result:
Four patients, two male, and two females, with a mean age of 62 years, had severe radicular pain worse on the left and mild back pain. In addition, two patients had severe claudication, and another had a motor deficit, table 1. The duration of symptoms of the patients was, on average, 49 months. Magnetic resonance imaging showed disc prolapse or canal stenosis in the lumbar spine (L4-S1). All patients were obese with BMI >30kg/m2. All patients underwent tubular MISS with the Viseon system, Video 1, with a 60 or 70 mm tube size. The system setup was quick and easy and did not require any assistance from the company. The image quality was very sharp but could not offer 3D visualization. The average duration of surgery was 146 min, with an average blood loss of 63mls. All patients were ambulant on the first-day post op with no post-op complications. The average time from admission to surgery was four days.

Conclusion:
Despite the lack of depth perception and a few episodes of frozen images while using monopolar, the Viseon MaxView camera system appears to be a feasible solution for MISS cases for patients in LMIC countries.