Seiki Yoshikatsu, Shibata Iekado, Oishi Hitoshi, Sanpei Kenji, Kano Toshiyuki, Utagawa Teruzo, Fukuyo Tsuneo
1st Department of Neurosurgery, Toho University, School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
No Shinkei Geka. 2002 Jun;30(6):601-6.
The employment of surgical microscopy in the field of neurosurgery has significantly contributed not only to the advancement of surgical technique, but also the operative outcome as well. This technology has allowed surgeons to meet the demands for increasingly difficult levels of surgery, which usually require a long operative time. However, the surgeon and the assistant are restricted in their posture for a long time, leading to excessive muscular and ocular stress. To solve these problems, we have developed and clinically applied a three dimensional video microscope system for surgery, using a two binocular camera method, that allows surgical procedures to be performed over a video monitor.
Two 3CCD cameras were installed on the assistant's lens attachment and the camera lens attachment of the microscope for neurosurgery, manufactured by Carl Zeiss Co., Ltd. The surgery was performed by viewing the three dimensional picture on the monitor, which was created by processing the images from the cameras by a time-division method. In November 1998, the prototype was completed and, with numerous modifications, its clinical application has become possible. Currently, we have used it in 42 clinical cases.
Even during a long surgical procedure, the posture of surgeon and assistant became less restricted since there was no need to look through the eyepiece of the microscope and led to significant decrease in physical fatigue and ocular strain. In the 42 clinical trials, the operation proceeded uneventfully, without any serious complications.
手术显微镜在神经外科领域的应用不仅显著推动了手术技术的进步，也改善了手术效果。这项技术使外科医生能够应对难度日益增加的手术需求，而此类手术通常需要较长的手术时间。然而，外科医生和助手会长时间保持受限的姿势，导致肌肉和眼部压力过大。为解决这些问题，我们开发并临床应用了一种用于手术的三维视频显微镜系统，采用双目相机方法，可通过视频监视器进行手术操作。
在卡尔·蔡司有限公司生产的神经外科手术显微镜的助手镜附件和相机镜头附件上安装了两台3CCD相机。通过时分法处理相机图像生成三维图像，手术通过在监视器上观看该图像进行。1998年11月，原型完成，经过多次改进后得以临床应用。目前，我们已在42例临床病例中使用了该系统。
1）外科医生和助手无需通过传统手术显微镜观察手术区域，而是通过偏光眼镜在视频监视器上观看立体视觉图像来进行显微手术。2）助手配备了单独的视频监视器，这样助手可以根据自己所站位置自由调整90 - 180度的视角。3）护士、住院医生和学生可以观看与外科医生相同的三维图像。这对教学环境有很大帮助。
即使在长时间的手术过程中，外科医生和助手的姿势受限程度也有所减轻，因为无需通过显微镜目镜观察，从而显著降低了身体疲劳和眼部疲劳。在42例临床试验中，手术顺利进行，未出现任何严重并发症。
