头高位与双目显微镜可视化系统在前节和后节手术中的比较：一项回顾性研究。

Comparing Heads-Up versus Binocular Microscope Visualization Systems in Anterior and Posterior Segment Surgeries: A Retrospective Study.

机构信息

Department of Ophthalmology, Hôpital Robert Debré, Reims, France,

Department of Ophthalmology, Hôpital Robert Debré, Reims, France.

出版信息

Ophthalmologica. 2020;243(5):347-354. doi: 10.1159/000507088. Epub 2020 Mar 11.

DOI:10.1159/000507088

PMID:32160616

Abstract

BACKGROUND

Three-dimensional (3D) visualization systems, also known as heads-up systems, are now available for eye surgery and as with every new device there is need for a specific evaluation.

OBJECTIVES

The aim of this study was to compare the efficiency, surgical comfort, and safety of a 3D visualization system to a standard binocular microscope (BM) in routine ophthalmologic procedures.

METHOD

After a 4-week training period, a 3D visualization system (Ngenuity, Alcon®) available in one of the Robert Debré Hospital Ophthalmology Departments' operating rooms was compared to a standard BM (OPMI LUMIRA 700, Zeiss®), in the process of a call for new device evaluation. From December 2017 to March 2018, 5 surgeons and their respective residents were asked to fill in a questionnaire for all procedures. Before the surgery, the surgeon recorded: (i) the type of surgery (cataract [PK], retinal detachment [RD], epiretinal membrane peeling [ERM], macular hole, vitreous haemorrhage [VH]), (ii) the type of visualization system chosen (3D or BM), and (iii) the estimated surgical risk (low, intermediate, or high grade). At the end of the procedure, the primary surgeon recorded the remaining parameters, including: (i) surgery duration, (ii) intraoperative complications, (iii) percentage of endoillumination for posterior segment surgeries, (iv) status of the operator (senior or resident) and operator switch if necessary (senior only, resident only, or resident with help of the senior), and rated: (i) the visual comfort (low, normal, excellent), (ii) the operative fluency (low, normal, excellent), (iii) backaches (none, low, moderate, important), and (iv) headaches (range from 0 to 10). Age and sex were collected retrospectively. The procedures performed with 3D and BM were subsequently compared using univariate (χ2, Fisher, Wilcoxon) and multivariate analysis (generalized linear model), allowing us to identify parameters independently associated with PK surgery duration.

RESULTS

A total of 102 valid questionnaires, relative to 73 PK and 29 vitreoretinal procedures, respectively, were analysed. As regards PK (3D, n = 25 vs. BM, n = 48), the mean age, sex ratio, surgical risk, intraoperative complications (1/25 vs. 4/48), visual comfort, backaches, and headaches were similar between the two systems. The use of 3D allowed faster PK surgeries (16.44 ± 4.36 vs. 21.44 ± 7.50 min; p = 0.007) and slightly enhanced the operative fluency. In vitreoretinal surgeries (3D, n = 14 vs. BM, n = 15), no obvious differences between the two visualization systems were observed, although the use of the 3D system was found to slightly decrease the operative fluency. Parameters independently associated with PK surgery duration were 3D visualization (β = -4.4 ± 1.4; p = 0.002), high preoperative surgical risk (β = 6.2 ± 2.4; p = 0.012), intraoperative complications (β = 8.7 ± 2.6; p = 0.001), and surgeon status (β = -4.4 ± 1.3; p = 0.001) in univariate and multivariate analysis.

CONCLUSIONS

3D visualization can be safely used in routine practice. It slightly improves the operative fluency, allowing faster PK surgery.

摘要

背景

三维（3D）可视化系统，也称为抬头系统，现已可用于眼部手术，由于每种新设备的出现，都需要对其进行特定的评估。

目的

本研究旨在比较 3D 可视化系统与标准双目显微镜（BM）在常规眼科手术中的效率、手术舒适度和安全性。

方法

在 4 周的培训期后，我们比较了一家罗伯特·德布雷医院眼科手术室中提供的 3D 可视化系统（Ngenuity，Alcon®）与标准 BM（OPMI LUMIRA 700，Zeiss®），这是新设备评估的一部分。从 2017 年 12 月至 2018 年 3 月，5 名外科医生及其各自的住院医生被要求为所有手术填写问卷。在手术前，外科医生记录：（i）手术类型（白内障[PK]、视网膜脱离[RD]、视网膜内膜剥除[ERM]、黄斑裂孔、玻璃体积血[VH]），（ii）选择的可视化系统类型（3D 或 BM），（iii）估计的手术风险（低、中、高等级）。手术结束时，主刀医生记录了剩余的参数，包括：（i）手术时间，（ii）术中并发症，（iii）后节手术的内照明百分比，（iv）外科医生的状态（高级或住院医生）以及是否需要切换（仅高级、仅住院医生或住院医生在高级医生的帮助下），并评价：（i）视觉舒适度（低、正常、优秀），（ii）手术流畅度（低、正常、优秀），（iii）背痛（无、低、中、重要），（iv）头痛（0 到 10 分）。年龄和性别是回顾性收集的。使用 3D 和 BM 进行的手术随后使用单变量（χ2、Fisher、Wilcoxon）和多变量分析（广义线性模型）进行比较，使我们能够识别与 PK 手术时间独立相关的参数。

结果

共分析了 102 份有效问卷，分别涉及 73 例 PK 和 29 例玻璃体视网膜手术。在 PK 方面（3D，n = 25 与 BM，n = 48），两种系统的平均年龄、性别比例、手术风险、术中并发症（1/25 与 4/48）、视觉舒适度、背痛和头痛相似。使用 3D 可以缩短 PK 手术时间（16.44 ± 4.36 与 21.44 ± 7.50 min；p = 0.007），并略微提高手术流畅度。在玻璃体视网膜手术中（3D，n = 14 与 BM，n = 15），两种可视化系统之间没有明显差异，尽管使用 3D 系统发现手术流畅度略有下降。与 PK 手术时间独立相关的参数是 3D 可视化（β = -4.4 ± 1.4；p = 0.002）、术前高手术风险（β = 6.2 ± 2.4；p = 0.012）、术中并发症（β = 8.7 ± 2.6；p = 0.001）和外科医生状态（β = -4.4 ± 1.3；p = 0.001），这在单变量和多变量分析中均成立。