A simple technique of photography with the operating microscope By LEONIDAS PAPANGELOU (Athens) 'SCRIPTA manent verba volent' or, according to the Chinese proverb, 'a picture is worth a thousand words'. This is true for all fields of the human spirit as well as for medicine where scientific knowledge and medical experiences are shared through scientific writing. Photography is an ideal means in the field of medicine for purposes of documentation and presentation of the results and findings of medical research and practice and is widely used today. As regards photography with the special photographic system of the operating microscope, it is expensive for private practice. The Zeiss operating microscope is an excellent type of binocular microscope. It permits photography through commercially available accessories for the application of the camera and the flash illumination system, but their commercial price is considerable. The purpose of this article is to present a simple, reliable and inexpensive technique of photography for making even coloured transparencies with the Zeiss operating microscope and a usual camera by the simple application of the camera lens on one of the oculars of the microscope. The light supply of the microscope with its 30 W. lamp is sufficient for commercially available films for artificial light. The external switch at the microscope base permits the selection of a 'medium' or 'high' intensity position during surgery. There are some restrictions for making pictures or coloured transparencies with the operating microscope: the minute photographic field as well as magnification which limits the depth of the field. A reflex camera is necessary for observation and focusing through the optical system of the microscope. The rigid attachment of the camera on the microscope is important for obtaining pictures or diapositives of high quality. My system for the camera adaptation on the microscope has been proved simple, inexpensive and uncomplicated, permitting quick attachment and removal of the camera to and from the microscope. It consists of three metallic rods fastened together in right angles with two screws (Fig. 1). The first rod (A) is screwed into the camera tripod thread. The third rod (C) is permanently fixed on a metallic ring fastened around the tube of the right ocular. The rigid attachment or removal of the camera on or from the microscope is made by the simple turn of a screw on or off (Figs. 2 and 3). Technical data to be observed for the technique in question are as follows:

(1) Once the operating microscope has been focused, the attached camera is also in focus regardless of the setting of the camera lens. However, as a routine technique the camera lens is set at infinity. The surgeon, can also use the camera viewer for fine focusing. 887

Leonidas Papangelou

FIG. I.

System for the camera adaptation on the microscope A, rod screwed into the camera tripod thread; C, rod fastened on the ocular tube of the microscope; B, rod connecting the rods A and C.

(2) The diaphragm plays no important role on the quality of the pictures. Nevertheless, a small diaphragm aperture gives sharper pictures and sufficient depth of field. (3) The exposure time required is 1 second for otomicroscopical findings and 2 seconds for microlaryngoscopy. (4) The light supply of the microscope with its 30 W. lamp is used, the intensity switch being at the 'medium' position. (5) The camera lens is 1 : 1 • 90/50 mm. (6) The commercially available Agfachrome 50 L film of artificial light for coloured transparencies gives excellent pictures. (7) The 10 x and 16 x setting of the microscope are used with a 12-5 X eyepiece.

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FIG. 2. Attachment or removal of the camera on or from the microscope by the simple turn of a screw on or off.

Surgical instruments of grey colour are preferable because they diminish light reflection and improve the quality of the pictures. Application of the above technical elements gives excellent pictures in nearly ioo per cent. Earlier attempts to make pictures by applying the camera on one of the oculars of a Zeiss operation microscope were more complicated (Myers et al., i960), and only occasionally gave usable results (Lundborg and Linzander, 1970). With this technique long exposure times are required since the illumination system of the microscope is the only light source used, any special device for momentous overvoltage of the lamp or an electronic flash unit not required. Long exposure makes practically no problem because microlaryngoscopy and 889

Leonidas Papangelou

FIG. 3. Camera rigidly attached on the microscope.

endolaryngeal microsurgery as well as many ear operations are performed under general endolaryngeal anaesthesia. The anaesthesiologist ceases aerization for one or two seconds and the patient remains still during photography. In ear operations under local anaesthesia it is easy to make the patient remain still for one second. With the presented technique, photography with the operating microscope is simple and quick since attachment and removal of the camera on and from the microscope is very easy without complicated manoeuvres elongating the operation time. It is also inexpensive and reliable, giving excellent results even in the hands of photographically inexperienced persons. 890

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Clinical records REFERENCES MYERS, D., BRENMAN, A. K., and SCHLOSSER, W. D. (i960) Medical

Radiography

and Photography, 36, 45. LUNDBORG, T., and LINZANDER, S. (1970) Ada Oto-laryngologica, Supplement 266. 18 Amerikis Street Athens 134 Greece.

EDITOR'S NOTE: The colour transparencies submitted with the paper were extremely good. Because of the high cost it is not possible to publish these and the monochrome reproductions were undistinguished and it is therefore not worth publishing these.

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