Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma
Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma
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紧凑型高清二维外窥镜在大型前庭神经鞘瘤手术治疗中的应用
DOI：
10.1097/cm9.0000000000000818
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发表时间：
2020-06-05
影响因子：
6.1
通讯作者：
Yue, Shu-Yuan
中科院分区：
文献类型：
--
作者：
Chen, Xin;Gao, Xiang-Liang;Yue, Shu-Yuan
摘要 背景：体外视频望远镜手术监护系统为进行高精度神经外科手术提供了必要的仪器，可以替代或补充传统的手术显微镜。本研究旨在评估紧凑型高清二维外窥镜系统，作为双目手术显微镜的替代方案，协助手术切除大型前庭神经鞘瘤（VS）。方法：2013 年 1 月至 2018 年 6 月期间，纳入 Koos 3 级和 4 级 VS 接受手术的患者参加这项前瞻性队列研究。两组患者的人口统计学和肿瘤特征（大小、Koos 分级、成分[囊性或实性肿块]）相匹配。比较两组之间的以下结果测量：手术持续时间、失血量、肿瘤切除范围、手术野调整次数、术后3个月评估的术前和术后面部和耳蜗神经功能、并发症和外科医生的舒适度。结果：共有 81 例患者在外窥镜（病例，n = 39）或手术显微镜（对照，n = 42）下通过乙状结肠后入路接受肿瘤切除术。两组患者的肿瘤位置（P = 0.439）、Koos分级（P = 0.867）和成分（P = 0.891）具有相似性。虽然手术时间（P = 0.172）、肿瘤切除范围（P = 0.858）、面部功能（P = 0.838）和听力（P = 1.000）没有显着差异，但在外镜下进行手术的患者失血量较少（P = 0.036）和视野调整较少（P < 0.001）。主科医生和助理外科医生均表示在外窥镜下操作的舒适度很高（分别为 P = 0.001 和 P < 0.001）。结论：与手术显微镜相比，紧凑型高清二维外窥镜系统提供了一种安全有效的方法来协助切除大的 VS。在通过动态提示和与运动视差相对应的立体观看熟悉视觉感知后，外窥镜系统提供了舒适、高分辨率的可视化，而不会影响操作效率和患者安全。
Abstract Background: Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope. Methods: Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons’ comfortability. Results: A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively). Conclusions: The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.