Neurosurg Focus. 2021 Jan;50(1):E18. doi: 10.3171/2020.10.FOCUS20786.
Extracorporeal telescopes (exoscopes) have been the latest addition to the neurosurgeons' armamentarium, acting as a bridge between operating microscopes and endoscopes. However, to the authors' knowledge there are no published preclinical laboratory studies of the accuracy, efficiency, and dexterity of neurosurgical training for the use of 2D or 3D exoscopes compared with microscopes.
In a controlled experimental setup, 22 participating neurosurgery residents performed simple (2D) and complex (3D) motor tasks with three visualization tools in alternating sequence: a 2D exoscope, 3D exoscope, and microscope, using a block randomization model based on the neurosurgeons' prior training experience (novice, intermediate, and senior: n = 6, 12, and 4, respectively). Performance scores (PS; including error and efficiency scores) and dexterity scores (DS) were calculated to objectify the accuracy, efficiency, and finesse of task performance. Repeated measures ANOVA analysis was used to compare the PS, DS, and cumulative scores (CS) of candidates using the three visualization aids. Bland-Altman plots and intraclass correlation coefficients were generated to quantify intraobserver and interobserver agreement for DS. Subgroup analysis was performed to assess the impact of participants' prior training. A postexercise survey was conducted to assess the comfort level (on a 10-point analog scale) of the participants while using each visualization tool for performing the suturing task.
PS, DS, and CS were significantly impacted by the visualization tool utilized for 2D motor tasks (p < 0.001 for each), with the microscope faring better than the 2D exoscope (p = 0.04) or 3D exoscope (p = 0.008). The PS for the 3D object transfer task was significantly influenced by the visualization aid used (p = 0.007), with the microscope and 3D exoscope faring better than the 2D exoscope (p = 0.04 for both). The visualization instrument used significantly affected the DS and CS for the suturing task (p < 0.001 for both), with the microscope again scoring better than the 2D exoscope (p < 0.001) or 3D exoscope (p = 0.005). The impact of the visualization aid was more apparent in participants with a shorter duration of residency (novice, p = 0.03; intermediate, p = 0.0004). Participants also felt the greatest operational comfort while working with a microscope, 3D exoscope, and 2D exoscope, in that order (p < 0.0001).
Compared with 3D and 2D exoscopes, an operating microscope provides better dexterity and performance and a greater operational comfort level for neurosurgeons while they are performing 2D or 3D motor tasks. For performing complex 3D motor tasks, 3D exoscopes offer selective advantages in dexterity, performance, and operational comfort level over 2D exoscopes. The relative impact of visualization aids on surgical proficiency gradually weakens as the participants' residency duration increases.
体外望远镜（外窥镜）是神经外科医生的最新武器，充当手术显微镜和内窥镜之间的桥梁。然而，据作者所知，与显微镜相比，目前还没有关于使用二维或三维外窥镜进行神经外科手术训练的准确性、效率和灵巧性的临床前实验室研究。
在一个对照实验装置中，22 名参与的神经外科住院医师使用三种可视化工具（2D 外窥镜、3D 外窥镜和显微镜）以交替顺序进行简单（2D）和复杂（3D）的运动任务，使用基于神经外科医生先前培训经验的随机分组模型（新手、中级和高级：n = 6、12 和 4）。计算性能评分（PS；包括误差和效率评分）和灵巧评分（DS），以客观地评估任务执行的准确性、效率和技巧。使用重复测量方差分析比较使用三种可视化辅助工具的候选者的 PS、DS 和累积评分（CS）。生成 Bland-Altman 图和组内相关系数，以量化 DS 的观察者内和观察者间一致性。进行亚组分析，以评估参与者先前培训的影响。在完成缝合任务后，对参与者使用每种可视化工具的舒适度（在 10 分模拟量表上）进行评估。
PS、DS 和 CS 均受到用于 2D 运动任务的可视化工具的显著影响（p < 0.001），显微镜的表现优于 2D 外窥镜（p = 0.04）或 3D 外窥镜（p = 0.008）。用于 3D 物体转移任务的 PS 明显受到所用可视化辅助工具的影响（p = 0.007），显微镜和 3D 外窥镜的表现优于 2D 外窥镜（p = 0.04）。用于缝合任务的可视化仪器的使用显著影响 DS 和 CS（均为 p < 0.001），显微镜再次优于 2D 外窥镜（p < 0.001）或 3D 外窥镜（p = 0.005）。可视化辅助工具的影响在住院时间较短的参与者中更为明显（新手，p = 0.03；中级，p = 0.0004）。参与者在使用显微镜、3D 外窥镜和 2D 外窥镜时的操作舒适度依次递增（p < 0.0001）。
与 3D 和 2D 外窥镜相比，手术显微镜在神经外科医生进行 2D 或 3D 运动任务时提供了更好的灵巧性和性能，以及更高的操作舒适度。对于进行复杂的 3D 运动任务，3D 外窥镜在灵巧性、性能和操作舒适度方面相对于 2D 外窥镜具有选择性优势。可视化工具对手术技能的影响随着参与者住院时间的增加而逐渐减弱。
Zotero 插件