Frykman Philip K, Duel Barry P, Gangi Alexandra, Williams James A, Berci George, Freedman Andrew L
Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Laparoendosc Adv Surg Tech A. 2013 Jul;23(7):639-43. doi: 10.1089/lap.2013.0125. Epub 2013 Jun 12.
Optical magnification is an essential tool in the practice of pediatric surgery. Magnifying loupes are the most frequently used instrument, although their use often comes at the expense of neck pain experienced by the operating surgeon. Recent advances have led to the development of a compact video microscope (VITOM(®); Karl Storz Endoscopy GmbH, Tuttlingen, Germany) that displays high-definition magnified images on a flat screen. This study was designed to evaluate VITOM as a potential substitute for loupes in complex open pediatric procedures and to explore VITOM as an effective intraoperative teaching modality for open surgery.
Three surgeons used the VITOM II exoscope in 20 operations: 14 hypospadias repairs, 2 inguinal hernia repairs, 1 sacrococcygeal teratoma resection, 1 recurrent tracheoesophageal fistula repair, and 2 additional procedures. Surgeons, trainees, and surgical technicians subjectively evaluated image quality; surgeons evaluated handling of VITOM, degree of neck strain, and fatigue. Three midlevel surgical trainees assessed the VITOM potential for teaching value. Overall impressions of each group and consensus opinions were generated.
All procedures were completed without complication. The consensus opinion of the entire group was that image quality was excellent. The surgeons found VITOM easy to use, and all agreed that neck strain and fatigue were reduced. Surgical trainees felt that VITOM imaging aided in their understanding of procedures and anatomy. Surgical technicians perceived improved operation flow through better visualization of the procedure.
VITOM provides excellent visualization of pediatric operations with improved surgeon comfort and may serve as a substitute for loupes. Secondarily, we found enhanced trainee learning and potential improvement in the flow of surgical procedures. Further study of VITOM with a larger sample size and validated tools is needed.
光学放大是小儿外科手术中的一项重要工具。放大倍数的放大镜是最常用的器械，尽管使用它常常会让主刀医生承受颈部疼痛。最近的进展促使了一种紧凑型视频显微镜（VITOM(®)；卡尔史托斯内窥镜有限公司，德国图特林根）的开发，该显微镜能在平板屏幕上显示高清放大图像。本研究旨在评估VITOM作为复杂开放性小儿手术中放大镜的潜在替代品，并探索VITOM作为开放性手术有效术中教学方式的可能性。
三位外科医生在20台手术中使用了VITOM II外视镜：14例尿道下裂修复术、2例腹股沟疝修补术、1例骶尾部畸胎瘤切除术、1例复发性气管食管瘘修复术以及另外2台手术。外科医生、实习生和手术技师对图像质量进行主观评估；外科医生评估VITOM的操作、颈部紧张程度和疲劳程度。三名中级外科实习生评估了VITOM的教学价值潜力。生成了每组的总体印象和共识意见。
所有手术均顺利完成，无并发症。整个小组的共识意见是图像质量极佳。外科医生发现VITOM易于使用，并且所有人都认为颈部紧张和疲劳减轻了。外科实习生认为VITOM成像有助于他们理解手术过程和解剖结构。手术技师通过更好地观察手术过程，感觉手术流程得到了改善。
VITOM能出色地显示小儿手术情况，提高了外科医生的舒适度，可作为放大镜的替代品。其次，我们发现实习生的学习得到了加强，手术流程也有潜在改善。需要使用更大样本量和经过验证的工具对VITOM进行进一步研究。
