Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Neurosurgery. 2010 Aug;67(2):476-83. doi: 10.1227/01.NEU.0000372204.85227.BF.
Advances in rigid-lens telescope systems provide an alternative method for magnification and illumination that may replace or supplement the operating microscope.
To evaluate the clinical utility of an exoscope system as an alternative to the operating microscope.
A custom-designed 10-mm-diameter rigid-lens telescope with a focal distance of 20 cm was attached to a 3-chip high-definition digital camera and displayed on a high-definition video monitor during surgery. A pneumatic scope holder positioned the scope over the operative field. This system was used in 16 procedures. The optical quality of the device was compared with that of an operating microscope during each procedure via a data entry form that evaluated optical quality, ease of manipulation, and overall ability to perform surgery.
The high-definition exoscope was used in 9 craniotomies, 6 spinal procedures, and 1 neurostimulator placement. Image quality was almost equal to that of the operating microscope in all cases. Surgeons felt that the lack of stereopsis with a monitor-based system was compensated for with repeated procedures, but the absence of true 3-dimensional viewing limited use in some cases. Scope repositioning was not as easy as the operating microscope counterbalance mechanism, and focusing was more cumbersome. These relative limitations minimized as experience was accumulated.
An exoscope has been developed for microneurosurgery with outstanding image quality and ease of manipulation that compares favorably with the microscope for many procedures. Refinement in the scope holder and the addition of 3-dimensional image display will improve user satisfaction. The current configuration is best suited for spinal neurosurgery and with refinement should have widespread application in neurosurgery.
硬性镜片望远镜系统的进步提供了一种替代放大和照明的方法，可替代或补充手术显微镜。
评估内窥镜系统作为手术显微镜替代物的临床实用性。
将一个定制的直径为 10 毫米、焦距为 20 厘米的硬性镜片望远镜连接到一个 3 芯片高清数字摄像机，并在手术过程中显示在高清视频监视器上。一个气动的镜架将镜架定位在手术区域上方。该系统在 16 个程序中使用。通过评估光学质量、操作便利性和手术整体能力的数据输入表，在每个程序中比较设备的光学质量与手术显微镜的光学质量。
高清内窥镜在 9 例开颅术、6 例脊柱手术和 1 例神经刺激器放置中使用。在所有情况下，图像质量几乎与手术显微镜相当。外科医生认为，基于监视器的系统缺乏立体感，但通过重复手术得到了补偿，而真正的三维观察限制了其在某些情况下的使用。镜架重新定位不像手术显微镜的平衡机制那么容易，而且聚焦更麻烦。随着经验的积累，这些相对的局限性最小化了。
已经开发出一种用于显微神经外科手术的内窥镜，具有出色的图像质量和易于操作，在许多手术中与显微镜相比具有优势。改进镜架和增加三维图像显示将提高用户满意度。当前配置最适合脊柱神经外科，经过改进后应广泛应用于神经外科。
