Aly A, Avila E, Cram A E
Department of Surgery, University of Iowa Health Care, Iowa City 52242, USA.
Surg Clin North Am. 2000 Oct;80(5):1373-82. doi: 10.1016/s0039-6109(05)70234-6.
This article discusses three of the most popular endoscopic procedures in plastic surgery. Brow lift, transaxillary breast augmentation, and abdominoplasty are all cosmetic procedures with a high demand on inconspicuous scars; however, many investigators are working on reconstructive endoscopically assisted procedures. The treatment of many facial fractures involving the upper third of the facial skeleton usually requires long bicoronal incisions similar to the incisions used in the traditional brow lift. Attempts are under way to use endoscopically assisted minimal-access techniques to reduce and fixate these fractures. Many flaps used in plastic surgery require long scars for harvest, as in the case of the latissimus dorsi muscle flap. A relatively long incision on the back is needed to gain access to the muscle so that it can be elevated from structures superficial and deep to it. Although it is unpopular, investigators have reported harvesting latissimus dorsi muscle flaps through fairly small incisions with the assistance of balloon dissectors and endoscopes. In the field of hand surgery, carpal tunnel release surgery has had more than one method proposed to transect the carpal ligament using endoscopes and special instrumentation. Although some reported series claim excellent results, many hand surgeons are reluctant to use endoscopes because of associated complications and a high recurrence rate of carpal tunnel syndrome. Plastic surgery has special demands that emphasize aesthetics in cosmetic and reconstructive procedures. Although the lack of natural optical cavities has slowed the incorporation of endoscopic surgery in the specialty, surgically created cavities are used to allow for minimal access incisions. The future of plastic surgery will include an ever-increasing number of endoscopically assisted procedures. Cosmetic and reconstructive procedures will benefit from this new technology.
本文讨论了整形外科中三种最流行的内镜手术。提眉术、经腋窝隆胸术和腹壁成形术都是对无痕疤要求很高的美容手术；然而，许多研究人员正在致力于内镜辅助重建手术。许多涉及面骨上三分之一的面部骨折的治疗通常需要类似传统提眉术所用的双侧冠状长切口。目前正在尝试使用内镜辅助的微创技术来复位和固定这些骨折。整形外科中使用的许多皮瓣在切取时需要很长的瘢痕，如背阔肌皮瓣的情况。需要在背部做一个相对较长的切口来暴露肌肉，以便将其从浅部和深部结构上掀起。尽管这种方法不太受欢迎，但研究人员报告称，在球囊分离器和内镜的辅助下，通过相当小的切口就能切取背阔肌皮瓣。在手部外科领域，已经提出了不止一种方法来使用内镜和特殊器械横断腕横韧带进行腕管松解手术。尽管一些报告的系列称效果极佳，但许多手外科医生由于相关并发症和腕管综合征的高复发率而不愿使用内镜。整形外科有特殊要求，在美容和重建手术中强调美学。尽管缺乏天然的光学腔隙减缓了内镜手术在该专业中的应用，但手术创建的腔隙可用于实现微创切口。整形外科的未来将包括越来越多的内镜辅助手术。美容和重建手术将受益于这项新技术。
