Belykh Evgenii G, Zhao Xiaochun, Cavallo Claudio, Bohl Michael A, Yagmurlu Kaan, Aklinski Joseph L, Byvaltsev Vadim A, Sanai Nader, Spetzler Robert F, Lawton Michael T, Nakaji Peter, Preul Mark C
Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.
Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , USA.
Cureus. 2018 Jul 30;10(7):e3072. doi: 10.7759/cureus.3072.
Background We assessed a new robotic visualization platform with novel user-control features and compared its performance to the previous model of operative microscope. Methods In a neurosurgery research laboratory, we performed anatomical dissections and assessed robotic, exoscopic, endoscopic, fluorescence functionality. Usability and functionality were tested in the operating room over 1 year. Results The robotic microscope showed higher sensitivity for fluorescein sodium, higher detail in non-fluorescent background, and recorded/presented pictures with color quality similar to observation through the oculars. PpIX visualization was comparable to the previous microscope. Near-infrared indocyanine green imaging 3-step replay allowed for more convenient accurate assessment of blood flow. Point lock and pivot point functions were used in dissections to create 3D virtual reality microsurgical anatomy demonstrations. Pivot point control was particularly useful in deep surgical corridors with dynamic retraction. 3D exoscopic function was successfully used in brain tumor and spine cases. Endoscopic assistance was used for around-the-corner views in minimally invasive approaches. We present illustrative cases highlighting utility and new ways to control the operative microscope. Conclusion Improvements of the robotic visualization platform include intraoperative fluorescence visualization using FNa, integrated micro-inspection tool, improved ocular imaging clarity, and exoscopic mode. New robotic movements positively assist the surgeon and provide improved ergonomics and a greater level of intraoperative comfort, with the potential to increase the viewing quality. New operational modes also allow significant impact for anatomy instruction. With the increasing number and complexity of functions, surgeons should receive additional training in order to avail themselves of the advantages of the numerous novel features.
背景 我们评估了一个具有新型用户控制功能的新型机器人可视化平台，并将其性能与之前的手术显微镜模型进行了比较。方法 在神经外科研究实验室中，我们进行了解剖操作，并评估了机器人、外视镜、内镜、荧光功能。在手术室中对其可用性和功能进行了为期1年的测试。结果 机器人显微镜对荧光素钠显示出更高的灵敏度，在非荧光背景下具有更高的细节，并且记录/呈现的图片颜色质量与通过目镜观察相似。原卟啉IX可视化与之前的显微镜相当。近红外吲哚菁绿成像的三步回放便于更准确地评估血流。在解剖操作中使用了点锁定和枢轴点功能来创建三维虚拟现实显微外科解剖演示。枢轴点控制在需要动态牵拉的深部手术通道中特别有用。三维外视镜功能成功应用于脑肿瘤和脊柱病例。在内镜辅助下用于微创入路的拐角视野。我们展示了一些说明性病例，突出了该手术显微镜的实用性和新的控制方式。结论 机器人可视化平台的改进包括使用荧光素钠进行术中荧光可视化、集成微检查工具、提高目镜成像清晰度以及外视镜模式。新的机器人动作能切实辅助外科医生，提供更好的人体工程学设计和更高的术中舒适度，还有提高观察质量的潜力。新的操作模式对解剖教学也有重大影响。随着功能数量和复杂性的增加，外科医生应接受额外培训，以便利用众多新功能的优势。
