Unit of Otorhinolaryngology, Head and Neck Department, San Paolo Hospital, University of Milan, Italy.
Acta Otorhinolaryngol Ital. 2013 Apr;33(2):102-6.
The recent introduction of the 3D endoscope for endonasal surgery has been welcomed because of its promise to overcome the main limitation of endoscopy, namely the lack of stereoscopic vision. This innovation particularly regarded the most complex transnasal surgery of the skull base. We therefore discuss our early experience as ENT surgeons with the use of a purely 3D endoscopic expanded endonasal approach for supradiaphragmatic lesions in 10 consecutive patients. This article will focus on the surgical technique, the complications, the outcome, and more importantly the advantages and limitations of the new device. We believe that the new 3D system shows its main drawback when surgery is conducted in the narrow nasal spaces. Nevertheless, the improved knowledge of the three-dimensional nasal anatomy enabled the ENT surgeon to perform a more selective demolition of the nasal structures even in the anterior part of the nose. The depth perception obtained with the 3D system also permitted a better understanding of the plasticity of the surgical defects, increasing the confidence to perform successful skull base plasties. We believe that, for both the ENT surgeon and the neurosurgeon, the expanded endonasal approach is the main indication for this exciting tool, although larger prospective studies are needed to determine the equality to the 2D HD endoscope in oncological terms.
最近引入的 3D 内窥镜用于经鼻内手术，因其有望克服内窥镜的主要限制，即缺乏立体视觉，而受到欢迎。这一创新特别针对颅底最复杂的经鼻手术。因此，我们作为耳鼻喉科医生，讨论了我们在 10 例连续患者中使用纯 3D 内窥镜扩展经鼻入路治疗膈上病变的早期经验。本文将重点介绍手术技术、并发症、结果，以及更重要的是新设备的优点和局限性。我们认为，当在狭窄的鼻腔空间进行手术时，新的 3D 系统显示出其主要缺点。然而，对三维鼻腔解剖结构的深入了解使耳鼻喉科医生能够选择性地破坏鼻腔结构，即使在鼻子的前部也是如此。3D 系统获得的深度感知还可以更好地理解手术缺陷的可塑，增加成功进行颅底整形术的信心。我们认为，对于耳鼻喉科医生和神经外科医生来说，扩展经鼻入路是这种令人兴奋的工具的主要适应证，尽管需要更大的前瞻性研究来确定在肿瘤学方面与 2D HD 内窥镜的平等性。
