2023 Global Health Engagement and Humanitarian Surgery Presentations

Andrew Francis, MD1; Daniel Lammers, MD1; Bobby Zhang, MD1; Beau Prey, MD1; James Williams, MD1; Jeffery Conner, MD1; Daniel Cuadrado, MD1; John McClellan, MD1; Matthew Eckert, MD1; Jason Bingham, MD1; Maziyar Askari, PhD2; Yang Lui, PhD2; 1Madigan Army Medical Center; 2University of Iowa

Objectives: Treatment of military casualties at night often requires the use of night vision devices (NVDs) to maintain light discipline under hostile conditions. Previous research tested tactical NVDs during the performance of 11 core surgical procedures and found that current technology is not adequate for surgery due to poor image quality, limited resolution at close distances, and lack of magnification. This project purpose-built a night vision prototype to address these limitations and optimize healthcare capabilities under low light scenarios in austere environments.

Methods: Develop a working night vision prototype and test the device during performance of operationally relevant surgical procedures on porcine and cadaveric models. Primary objectives: high-definition image quality, continuous digital magnification, user-demand autofocus, and dynamic working distance. Secondary objectives: ultrasound and vital sign integration, telemedicine capability, fluorescence detection, and a low-light mode offering visualization in full color. The current prototype consists of four modules. Imaging module utilizes two complementary metal-oxide-semiconductor image sensors for true stereoscopic night vision. Illumination module utilizes light-emitting diodes. Display module utilizes customized liquid crystal on silicon microdisplays to enable 3D visualization. Control module operates the device and processes the image data.

Results: The following capabilities are built and functional: Native, stereoscopic night vision with high image quality, resolution, and contrast. Adjustable surgical magnification ranging from 1.5-6.0x with 0.1x incremental adjustment. Autofocus with <0.6sec delay. Dynamic working distance that supports different users, procedures, and surgeries. Wireless field-of-view vital sign and ultrasound monitoring with color doppler, which is a picture-in-picture overlay inside the field-of-view. A low-light mode offering high-definition visualization in full color for use when ambient light is tactically feasible. Fluorescence detection can be enabled as an option. Testing conducted by military surgeons and 2nd Ranger Battalion medics showed that operation of the prototype is intuitive and first-time users without prior training were immediately able to perform complex surgical procedures safely and effectively under blackout conditions.

Conclusions: This project successfully developed a working NVD prototype capable of high-definition digital magnification with autofocus, wireless ultrasound and vital sign picture-in-picture integration, and a low-light mode offering full color. Due to the native night vision capabilities, the device inherently eliminates all shadows in the surgical field and essentially replaces both surgical loupes and headlamps. Development of telemedicine capability into the NVD prototype is currently underway. Using this device, surgeons and medics will be able to provide complex medical care under blackout conditions while maintaining strict light discipline.