Jain R, Kato Y, Sano H, Imizu S, Watanabe S, Yamaguchi S, Shinya N, Jindal V, Kanno T
Department of Neurosurgery, Fujita Health University, Japan.
Minim Invasive Neurosurg. 2003 Aug;46(4):235-9. doi: 10.1055/s-2003-42355.
Minimally invasive surgeries by innovative approaches are practiced in all fields. The evolution of microneurosurgery has revolutionized the results in neurosurgery. Use of endoscopes and navigation has made microsurgery less invasive. Another development to make minimally invasive microneurosurgery further lesser invasive is the use of micromanipulator. The use and effectiveness of manually controlled micromanipulator system is presented. The manually controlled micromanipulator system consists of three parts, i.e., a basic micromanipulator, manipulator supporting device and the manual control. The micromanipulator fitted in supporting device is arranged before the start of surgery. The supporting device used is pneumatically driven powered endoscopic holding device (Mitaka Kohki Co., Tokyo) In maximum number of times we used the system for endoscopic assisted cerebrovascular microneurosurgery. In a span of two months we used it in thirty aneurysm clipping surgeries. The endoscope fitted in system has three ranges of motions (forward/backward, upside/down and sideways). We use MACHIDA rigid endoscope with internal diameter of 2.7 mm (smallest diameter endoscope available). Special features of this endoscope are accurate visualization at a deeper plane, stable movements and availability of single focus point for long time. All these features are valuable during pre- and postoperative clipping observation. The aim of development of micromanipulator system was to further reduce invasiveness. A significant improvement in manual dexterity is possible when working through the micromanipulator interface, which dampens human physiological tremor. The physiological tremor would render the manual dexterity unsafe at the end of lever arm of long instruments. Thus, the use endoscope becomes practical. The minimally invasive microneurosurgery can be further made lesser invasive by use of micromanipulator and we are convinced that this will facilitate more accurate and promising results in microneurosurgery.
创新方法的微创手术在各个领域都有应用。显微神经外科的发展彻底改变了神经外科的治疗效果。内窥镜和导航技术的应用使显微手术的创伤性更小。使微创显微神经外科手术创伤进一步减小的另一项进展是使用显微操作器。本文介绍了手动控制显微操作器系统的使用方法及效果。手动控制显微操作器系统由三部分组成，即基本显微操作器、操作器支撑装置和手动控制装置。安装在支撑装置中的显微操作器在手术开始前布置好。所使用的支撑装置是气动驱动的内镜固定装置（日本东京三鹰光器株式会社）。我们在大多数情况下将该系统用于内窥镜辅助脑血管显微神经外科手术。在两个月的时间里，我们在30例动脉瘤夹闭手术中使用了该系统。系统中安装的内窥镜有三个运动范围（前后、上下和左右）。我们使用内径为2.7毫米的真田刚性内窥镜（可获得的最小直径内窥镜）。这种内窥镜的特点是在更深平面能实现精确可视化、运动稳定且长时间保持单点聚焦。所有这些特点在术前和术后夹闭观察中都很有价值。显微操作器系统的开发目的是进一步降低侵袭性。通过显微操作器界面操作时，手动灵活性会有显著提高，该界面可抑制人体生理震颤。在长器械杠杆臂末端，生理震颤会使手动灵活性变得不安全。因此，内窥镜的使用变得切实可行。通过使用显微操作器，微创显微神经外科手术的创伤可以进一步减小，我们相信这将有助于在显微神经外科手术中取得更准确、更有前景的结果。
