Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
World Neurosurg. 2019 Oct;130:e244-e250. doi: 10.1016/j.wneu.2019.06.049. Epub 2019 Jun 14.
Anterior cervical discectomy and fusion (ACDF) remains one of the most commonly taught procedures during residency and one of the most frequently performed by neurosurgeons. Neurosurgeons use microscopes to perform surgery and to train other surgeons. Although the microscope provides excellent illumination and magnification, its use will be limited to 2 people: the surgeon and the assistant. Consequently, the scrub nurse and residents watching 2-dimensional images on monitors will have a reduced perception of the surgical field depth and anatomical details. The exoscope has been introduced as an alternative to microscopes and endoscopes. We used a 3-dimensional (3D), high-definition exoscope (3D Vitom [Karl Storz, Tuttlingen, Germany]) in 2 patients undergoing 2-level ACDF for cervical myeloradiculopathy.
The exoscope was used during soft tissue dissection, discectomy, osteophytectomy, and cage insertion. Microsurgical drilling of the posterior osteophytes, which will usually require adequate magnification and proper microscope angulation, was also performed using the exoscope.
The exoscope provided a 3D view of the surgical field similar to that provided by a microscope and allowed us to effectively and safely perform the required surgical steps. The main advantage of 3D exoscope-assisted surgery, compared with microscope-assisted surgery, is the possibility to generate videos with a similar view and image quality as perceived by the surgeon. Therefore, the didactic capabilities of exoscopic videos are greater than those provided by microscopic videos. Exoscopes are also smaller compared with microscopes, allowing for comfortable use from the early surgical steps to device implantation.
We believe that exoscope-assisted surgery could become a safe and effective alternative to microscope-assisted surgery in ACDF.
颈椎前路椎间盘切除融合术（ACDF）仍然是住院医师培训中最常教授的手术之一，也是神经外科医生最常进行的手术之一。神经外科医生使用显微镜进行手术并培训其他外科医生。尽管显微镜提供了极好的照明和放大效果，但它的使用将仅限于两个人：外科医生和助手。因此，洗手护士和在监视器上观看二维图像的住院医师对手术区域的深度和解剖细节的感知会降低。外窥镜已被引入作为显微镜和内窥镜的替代品。我们在 2 例因颈椎神经根病而行 2 级 ACDF 的患者中使用了三维（3D）高清外窥镜（3D Vitom[Karl Storz，德国图特林根]）。
在外窥镜下进行软组织解剖、椎间盘切除术、骨赘切除术和椎间融合器插入术。外窥镜还用于进行后骨赘的显微钻孔，这通常需要足够的放大倍数和适当的显微镜角度。
外窥镜提供了与显微镜相似的手术区域 3D 视图，使我们能够有效地、安全地进行所需的手术步骤。与显微镜辅助手术相比，3D 外窥镜辅助手术的主要优势是可以生成与外科医生感知到的类似视图和图像质量的视频。因此，外窥镜视频的教学效果大于显微镜视频。与显微镜相比，外窥镜也更小，允许从早期手术步骤到器械植入的舒适使用。
我们认为外窥镜辅助手术可能成为 ACDF 中显微镜辅助手术的一种安全有效的替代方法。
