Capturing Extraocular Surgery on Video

You can’t learn surgery from a book. Hence the growing popularity of videotaped surgical procedures as a teaching tool for medical residents.

In ophthalmology, residents can go online to access countless high-quality videos of procedures like cataract or glaucoma surgery. These videos are produced by mounting a coaxial camera to the surgeon’s microscope, making it possible to capture exactly what the surgeon sees.

But as Nathan Liles, M.D., realized during his residency and pediatric ophthalmology fellowship at Kellogg, videotaping procedures that typically don’t use a microscope, like many forms of strabismus surgery, presents a challenge.

Where do you put the camera?

For non-microscope procedures, surgeons wears ‘loupes’, telescopic magnifying lenses mounted to eyeglasses to provide the necessary detail in a wide enough view. “Loupes don’t lend themselves to a camera mount,” he explains. “And it’s virtually impossible to capture an unobstructed surgeon’s point-of-view with a camera mounted to a wall or light source.”

For Dr. Liles, the solution was right under his nose—or rather, on the top of his head. “I thought about how head-mounted cameras are used to produce amazing point-of-view videos of sports like skiing and skydiving,” he says. “I figured making it work for extraocular surgery was just a matter of adding up-close definition.”

After researching different commercial telescopic lenses, Dr. Liles found one that could be adapted to fit head-mounted cameras to provide 2.5x magnification, the same as that achieved with the surgical loupes.

Now a member of the Pediatric Ophthalmology faculty at Kellogg, Dr. Liles has used his device to record 4k-quality videos of dozens of surgeries, including many strabismus procedures. “In many cases I also filmed versions without magnification to broaden the field of view,” he explains, “to allow the viewer to see the hands of the surgeons and assistants.”

Kellogg surgical residents are currently using Dr. Liles’ videos to augment traditional forms of study. Work is underway to complete a website to house a full catalog of videos.