Marcus Hani J, Cundy Thomas P, Hughes-Hallett Archie, Yang Guang-Zhong, Darzi Ara, Nandi Dipankar
Department of Neurosurgery, Imperial College Healthcare NHS Trust , London , UK.
Br J Neurosurg. 2014 Oct;28(5):606-10. doi: 10.3109/02688697.2014.887654. Epub 2014 Feb 17.
The literature reflects a resurgence of interest in endoscopic and keyhole endoscope-assisted neurosurgical approaches as alternatives to conventional microsurgical approaches in carefully selected cases. The aim of this study was to assess the technical challenges of neuroendoscopy, and the scope for technological innovations to overcome these barriers.
All full members of the Society of British Neurosurgeons (SBNS) were electronically invited to participate in an online survey. The open-ended structured survey asked three questions; firstly, whether the surgeon presently utilises or has experience with endoscopic or endoscope-assisted approaches; secondly, what they consider to be the major technical barriers to adopting such approaches; and thirdly, what technological advances they foresee improving safety and efficacy in the field. Responses were subjected to a qualitative research method of multi-rater emergent theme analysis.
Three clear themes emerged: 1) surgical approach and better integration with image-guidance systems (20%), 2) intra-operative visualisation and improvements in neuroendoscopy (49%), and 3) surgical manipulation and improvements in instruments (74%).
The analysis of responses to our open-ended survey revealed that although opinion was varied three major themes could be identified. Emerging technological advances such as augmented reality, high-definition stereo-endoscopy, and robotic joint-wristed instruments may help overcome the technical difficulties associated with neuroendoscopic approaches.
Results of this qualitative survey provide consensus amongst the technology end-user community such that unambiguous goals and priorities may be defined. Systems integrating these advances could improve the safety and efficacy of endoscopic and endoscope-assisted neurosurgical approaches.
文献表明，在经过精心挑选的病例中，作为传统显微外科手术方法的替代方案，内镜及锁孔内镜辅助神经外科手术方法重新引起了人们的关注。本研究的目的是评估神经内镜的技术挑战，以及通过技术创新克服这些障碍的可能性。
以电子方式邀请英国神经外科医生协会（SBNS）的所有正式成员参与在线调查。开放式结构化调查提出了三个问题：第一，外科医生目前是否使用内镜或内镜辅助手术方法或是否有相关经验；第二，他们认为采用此类手术方法的主要技术障碍是什么；第三，他们预计哪些技术进步能提高该领域的安全性和有效性。对回复采用多评估者新兴主题分析的定性研究方法。
出现了三个明确的主题：1）手术入路及与图像引导系统更好的整合（20%），2）术中可视化及神经内镜的改进（49%），3）手术操作及器械的改进（74%）。
对我们开放式调查回复的分析表明，尽管观点各异，但可以确定三个主要主题。增强现实、高清立体内镜和机器人腕关节器械等新兴技术进步可能有助于克服与神经内镜手术方法相关的技术困难。
本次定性调查的结果在技术终端用户群体中达成了共识，从而可以明确目标和优先事项。整合这些进步的系统可以提高内镜及内镜辅助神经外科手术方法的安全性和有效性。
