Hofer M, Runge A, Haase R, Neumuth T, Maier T, Lueth T, Dietz A, Strauss G
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde/Plastische Operationen, Universitätsklinikum Leipzig, Liebigstr 10-14, 04103 Leipzig.
HNO. 2012 Feb;60(2):109-16. doi: 10.1007/s00106-011-2374-0.
Surgical accuracy in microscopic ear surgery is reduced by limited access and tremor. At this point a micromanipulator could have a positive influence. The goal of the study was: 1. To develop a system that would enable measurements of accuracy, time and precision during a manual approach to the middle ear 2. To apply a manipulator that can easily be a compact part of the regular setup in ear surgery 3. To compare the manual results critically considering accuracy and tremor reduction and to compare these results with those of a manipulator A manipulator in ear surgery does not need to be a highly complex structure with force feedback and multiple degrees of freedom. The surgeon's preparation in middle ear surgery is most of the time straight without potentially applying the 15 degrees of freedom the human hand can offer. The micromanipulator in this study was developed in order to serve as a compact, teleoperated instrument without limiting the surgeon's dexterity. The use of standard instruments facilitates the integration of the system in existing surgical procedures and sterilisation concepts.
Ten head and neck surgeons simulated an approach to the stapedial footplate on a modified 3D cast of a realistic human skull in an experimental OR. A perforator was moved to a reference point on the stapedial footplate. The movements were detected by means of an image acquisition system. Each trial was repeated more than 200 times, aiming both manually and with the aid of a micromanipulator (> 4,000 measurements).
Accuracy for the manual and micromanipulator approach revealed no considerable differences. In absolute terms, the manual approach was more accurate. However, the learning curves indicated a stronger decrease in deviation when the micromanipulator was used and also less deviation in scatter plots. At the beginning, the time required for pointing increased when using the micromanipulator, but decreased to a greater extent in the course of the trial when compared to the manual approach. The work strain was distinctively lower when the micromanipulator was applied.
The micromanipulator gave evidence of a stronger effect as regards individual improvement in accuracy and time span. The micromanipulator shows potential for improvements in accuracy as well as compensation for poor ergonomics.
在显微耳科手术中，有限的操作空间和震颤会降低手术的精确性。此时，显微操作器可能会产生积极影响。本研究的目标是：1. 开发一种系统，能够在手动进入中耳的过程中测量精确性、时间和精度；2. 应用一种易于成为耳科手术常规设置紧凑组成部分的操作器；3. 严格考虑精确性和震颤减少情况，比较手动操作的结果，并将这些结果与操作器的结果进行比较。耳科手术中的操作器无需是具有力反馈和多个自由度的高度复杂结构。中耳手术中外科医生的操作大多时候是直接的，无需使用人手所能提供的15个自由度。本研究中的显微操作器是为作为一种紧凑的远程操作仪器而开发的，不会限制外科医生的灵活性。使用标准器械便于将该系统集成到现有的手术程序和消毒概念中。
10名头颈部外科医生在实验手术室中，在一个经过改良的逼真人类头骨3D模型上模拟接近镫骨足板的操作。使用穿孔器移动到镫骨足板上的一个参考点。通过图像采集系统检测动作。每个试验重复200多次，分别进行手动操作和借助显微操作器操作（超过4000次测量）。
手动操作和使用显微操作器的操作在精确性方面没有显著差异。从绝对值来看，手动操作更精确。然而，学习曲线表明，使用显微操作器时偏差下降得更明显，散点图中的偏差也更小。开始时，使用显微操作器指向所需的时间增加，但与手动操作相比，在试验过程中下降幅度更大。使用显微操作器时工作压力明显更低。
显微操作器在提高个体精确性和缩短时间方面显示出更强的效果。显微操作器在提高精确性以及弥补人体工程学不足方面具有潜力。
