Clancy Neil T, Clark James, Noonan David P, Yang Guang-Zhong, Elson Daniel S
Imperial College London, London, UK.
Surg Innov. 2012 Jun;19(2):134-44. doi: 10.1177/1553350611421021. Epub 2011 Sep 26.
Minimally invasive surgical techniques such as single access and natural orifice translumenal endoscopic surgery (NOTES) aim to reduce the number of external scars on the patient but impose restrictions on the space available for the light source within the endoscope and, therefore, the size of the field of view that can be sufficiently illuminated.
This article presents and compares a number of illumination methods (xenon, light-emitting diodes, laser/phosphor, supercontinuum laser) that could be applied in single-access, robotic, and NOTES procedures. The luminance, spectral content, and intensity profile of each source was measured. Standardized images of each illuminating an abdominal simulator were assessed by a group of surgeons to provide an initial clinical impression.
The xenon source was found to have the highest luminance when used with a standard laparoscopic light cable, but this was significantly reduced when used with a small cable suitable for single-access applications. The supercontinuum laser-based light source had brightness comparable to the xenon, which was supported by the surgical test group observations.
The supercontinuum fiber probe is a potential alternative to xenon light sources for use in single-access surgery with its comparable luminance, small diameter, flexibility, and even illumination. An initial in vivo test is described, providing a guide for future development.
诸如单通道入路和经自然腔道内镜手术（NOTES）等微创手术技术旨在减少患者体表的瘢痕数量，但会限制内镜内光源的可用空间，进而限制可获得充分照明的视野大小。
本文介绍并比较了多种可应用于单通道入路、机器人辅助及NOTES手术的照明方法（氙气灯、发光二极管、激光/荧光粉、超连续谱激光）。测量了每种光源的亮度、光谱成分和强度分布。一组外科医生对每种光源照亮腹部模拟器的标准化图像进行评估，以提供初步临床印象。
发现氙气灯与标准腹腔镜光缆配合使用时亮度最高，但与适用于单通道入路应用的小光缆配合使用时，亮度显著降低。基于超连续谱激光的光源亮度与氙气灯相当，这得到了手术测试组观察结果的支持。
超连续谱光纤探头因其亮度相当、直径小、柔韧性好且照明均匀，是单通道入路手术中氙气光源的潜在替代方案。本文描述了初步的体内测试，为未来发展提供了指导。
