Initial Clinical Experience With a High-Definition Exoscope System for Microneurosurgery
Initial Clinical Experience With a High-Definition Exoscope System for Microneurosurgery
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DOI：
10.1227/01.neu.0000372204.85227.bf
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发表时间：
2010-08-01
期刊：
影响因子：
4.8
通讯作者：
Berci, George
中科院分区：
文献类型：
--
作者：
Mamelak, Adam N.;Nobuto, Toshiko;Berci, George
背景：硬镜望远镜系统的进步提供了一种替代或补充手术显微镜的放大和照明方法。目的：评估外镜系统作为手术显微镜替代品的临床实用性。方法：将定制设计的直径10 mm、焦距为20 cm的硬镜望远镜连接到3芯片高清数码相机上，并在手术过程中显示在高清视频监视器上。气动内窥镜支架将内窥镜定位在手术区域上方。该系统被用于 16 个程序。在每次手术过程中，通过数据输入表格将该设备的光学质量与手术显微镜的光学质量进行比较，评估光学质量、操作简便性和整体手术能力。 结果：高清外窥镜用于 9 例开颅手术、6 例脊柱手术和 1 例神经刺激器放置。在所有情况下，图像质量几乎与手术显微镜相同。外科医生认为，基于监视器的系统缺乏立体视觉，可以通过重复手术来弥补，但缺乏真正的 3 维观察在某些情况下限制了使用。内窥镜重新定位不像手术显微镜平衡机构那么容易，而且对焦也更麻烦。随着经验的积累，这些相对限制被最小化。结论：已经开发出用于显微神经外科的外窥镜，其具有出色的图像质量和易于操作性，在许多手术中与显微镜相比具有优势。瞄准镜支架的改进和 3 维图像显示的添加将提高用户满意度。目前的配置最适合脊柱神经外科，经过改进应该可以在神经外科中得到广泛的应用。
BACKGROUND: Advances in rigid-lens telescope systems provide an alternative method for magnification and illumination that may replace or supplement the operating microscope.OBJECTIVE: To evaluate the clinical utility of an exoscope system as an alternative to the operating microscope.METHODS: A custom-designed 10-mm-diameter rigid-lens telescope with a focal distance of 20 cm was attached to a 3-chip high-definition digital camera and displayed on a high-definition video monitor during surgery. A pneumatic scope holder positioned the scope over the operative field. This system was used in 16 procedures. The optical quality of the device was compared with that of an operating microscope during each procedure via a data entry form that evaluated optical quality, ease of manipulation, and overall ability to perform surgery.RESULTS: The high-definition exoscope was used in 9 craniotomies, 6 spinal procedures, and 1 neurostimulator placement. Image quality was almost equal to that of the operating microscope in all cases. Surgeons felt that the lack of stereopsis with a monitor-based system was compensated for with repeated procedures, but the absence of true 3-dimensional viewing limited use in some cases. Scope repositioning was not as easy as the operating microscope counterbalance mechanism, and focusing was more cumbersome. These relative limitations minimized as experience was accumulated.CONCLUSIONS: An exoscope has been developed for microneurosurgery with outstanding image quality and ease of manipulation that compares favorably with the microscope for many procedures. Refinement in the scope holder and the addition of 3-dimensional image display will improve user satisfaction. The current configuration is best suited for spinal neurosurgery and with refinement should have widespread application in neurosurgery.