Department of Surgical Oncology and Technology, Imperial College, London, UK.
Surg Endosc. 2010 Aug;24(8):2013-21. doi: 10.1007/s00464-010-0897-1. Epub 2010 Feb 23.
"Tunnel vision" associated with endoscopes used in NOTES and laparoscopes used in laparoendoscopic single-site surgery (LESS) procedures present the surgeon with a disorienting view of familiar surroundings. Given the in-line arrangement of the devices, it is difficult to achieve adequate triangulation, a critical component of successful surgical technique. A potentially more useful vantage point would be from above, looking down at the surgical field, i.e., "stadium view." The purpose of this study was to develop stadium-view camera prototypes for evaluation.
Cylindrical (15 mm diameter, 30 mm length) imagers were built using white light LEDs for illumination and a near-VGA resolution CMOS camera. These prototypes were delivered to the abdominal cavity through an overtube (Steerable Flex Trocar (SFT)); the electronic tether for power and video signal was pulled through the abdominal wall using a 2-mm rigid grasper. The prototypes were attracted to the abdominal wall magnetically. Clinicians performed the procedures in IACUC/Home Office-approved porcine labs.
Introduction of the device into the peritoneal cavity and magnetic coupling to the abdominal wall were straightforward. Illumination was adequate to provide reasonable imagery of nearby abdominal organs. Bowel was successfully sutured laparoscopically under visualization provided by the prototype. All points on the abdominal wall could be reached via the magnetic control, and the camera could be successfully aimed through abdominal palpation. Retrieval was uncomplicated.
The prototypes provide the clinician a point of view similar to that of a traditional laparoscope, although the image quality needs improvement. The stadium view helps to overcome limitations associated with in-line visualization and working tools. Use of such a camera in NOTES or LESS could enable reduction of the number/size of ancillary trocars, reduce the size of the LESS port, and/or increase the number of working devices that can be deployed.
NOTES 中使用的内窥镜和 laparoendoscopic 单部位手术（LESS）中使用的腹腔镜会使外科医生产生一种熟悉环境的定向障碍。鉴于设备的直线排列，很难实现足够的三角测量，这是成功手术技术的关键组成部分。一个更有用的视角可能是从上往下看手术区域，即“体育场视图”。本研究的目的是开发体育场视图相机原型进行评估。
使用白色发光二极管（LED）进行照明和近 VGA 分辨率 CMOS 相机构建圆柱形（直径 15 毫米，长 30 毫米）成像器。这些原型通过外套管（可转向 Flex Trocar（SFT））递送到腹腔；电子系绳用于电源和视频信号通过 2 毫米刚性抓握器穿过腹壁。原型通过磁力吸引到腹壁上。临床医生在 IACUC/家庭办公室批准的猪实验室中进行了这些操作。
将设备引入腹腔并与腹壁磁耦合非常简单。照明足以提供附近腹部器官的合理图像。在原型提供的可视化下，成功地进行了腹腔镜下的肠缝合。可以通过磁性控制到达腹壁的所有点，并且可以通过腹部触诊成功瞄准相机。检索并不复杂。
原型为临床医生提供了类似于传统腹腔镜的视角，尽管图像质量需要改进。体育场视图有助于克服与直线可视化和工作工具相关的限制。在 NOTES 或 LESS 中使用这种相机可以减少辅助套管针的数量/尺寸，减少 LESS 端口的尺寸，并且/或者增加可以部署的工作设备的数量。
