Microvascular anastomosis under 3D exoscope or endoscope magnification: A proof-of-concept study.
Microvascular anastomosis under 3D exoscope or endoscope magnification: A proof-of-concept study.
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在3D外观或内窥镜放大倍率下的微血管吻合：一项概念验证研究。
DOI：
10.4103/sni.sni_36_18
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发表时间：
2018
影响因子：
--
通讯作者：
Preul MC
中科院分区：
文献类型：
--
作者：
Belykh E;George L;Zhao X;Carotenuto A;Moreira LB;Yağmurlu K;Bozkurt B;Byvaltsev VA;Nakaji P;Preul MC
颅外-颅内搭桥术是一项具有挑战性的手术，需要特殊的显微外科技能和手术显微镜。外窥镜是一种神经外科可视化工具，可在类似于内窥镜的平视显示器上提供视图，但像显微镜一样位于手术区域外部。作者进行了一项概念验证研究，评估使用各种新型外窥镜工具进行微血管旁路手术的可行性和有效性。我们使用三维 (3D) 内窥镜、免提机器人自动定位二维 (2D) 外窥镜和无眼 3D 外窥镜评估显微外科手术，包括手术纱布结扎、手术手套切割、胎盘血管吻合和大鼠血管吻合。对不同可视化工具和标准手术显微镜的图像质量、有效性和可行性进行了比较。 3D 内窥镜成像的分辨率相对较差。它被证明足以用于胎盘动脉的打结和吻合，但不适合大鼠的吻合。 2D 外窥镜提供了更高分辨率的成像，但由于缺乏深度感知，不足以满足所有操作。 3D 外窥镜由于其深度感知和更高的分辨率而被证明可以完成所有操作。微血管搭桥手术需要最高放大倍数下的深度感知和高分辨率。由于深度感知相关的限制，使用 2D 成像方式执行标准微吻合技术并不成功。 3D外视镜下微血管吻合可行；然而，在最高放大倍数下，深度感知不如标准手术显微镜提供的深度感知，这阻碍了手术。
Extracranial–intracranial bypass is a challenging procedure that requires special microsurgical skills and an operative microscope. The exoscope is a tool for neurosurgical visualization that provides view on a heads-up display similar to an endoscope, but positioned external to the operating field, like a microscope. The authors carried out a proof-of-concept study evaluating the feasibility and effectiveness of performing microvascular bypass using various new exoscopic tools. We evaluated microsurgical procedures using a three-dimensional (3D) endoscope, hands-free robotic automated positioning two-dimensional (2D) exoscope, and an ocular-free 3D exoscope, including surgical gauze knot tying, surgical glove cutting, placental vessel anastomoses, and rat vessel anastomoses. Image quality, effectiveness, and feasibility of each technique were compared among different visualization tools and to a standard operative microscope. 3D endoscopy produced relatively unsatisfactory resolution imaging. It was shown to be sufficient for knot tying and anastomosis of a placental artery, but was not suitable for anastomosis in rats. The 2D exoscope provided higher resolution imaging, but was not adequate for all maneuvers because of lack of depth perception. The 3D exoscope was shown to be functional to complete all maneuvers because of its depth perception and higher resolution. Depth perception and high resolution at highest magnification are required for microvascular bypass procedures. Execution of standard microanastomosis techniques was unsuccessful using 2D imaging modalities because of depth-perception-related constraints. Microvascular anastomosis is feasible under 3D exoscopic visualization; however, at highest magnification, the depth perception is inferior to that provided by a standard operative microscope, which impedes the procedure.