Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa City, Ishikawa, Japan.
Department of HBP and Transplant Surgery, Kyoto University, Kyoto City, Kyoto, Japan.
PLoS One. 2021 May 12;16(5):e0250559. doi: 10.1371/journal.pone.0250559. eCollection 2021.
Microsurgery using conventional optical microscopes or surgical loupes features a limited field of view and imposes a serious strain on surgeons especially during long surgeries. Here we advocate the micro- and macro-borderless surgery (MMBS) using a novel high-resolution (4K) three-dimensional (3D) video system. This study aimed to confirm the applicability of this concept in several surgical procedures.
We evaluated the possible use and efficacy of MMBS in the following experiments in porcine subjects. Experiment 1 (non-inferiority test) consisted of dissection and anastomosis of carotid artery, portal vein, proper hepatic artery, and pancreatoduodenectomy with surgical loupe versus MMBS. Experiment 2 (feasibility test) consisted of intra-abdominal and intra-thoracic smaller arteries anastomosed by MMBS as a pre-clinical setting. Experiment 3 (challenge on new surgery) consisted of orthotopic liver transplantation of the graft from a donor after circulatory death maintained by machine perfusion. Circulation of the cardiac sheet with a vascular bed in experiment 2 and liver graft during preservation in experiment 3 was evaluated with indocyanine green fluorescence imaging equipped with this system.
Every procedure was completed by MMBS. The operator and assistants could share the same field of view in heads-up status. The focal depth was deep enough not to be disturbed by pulsing blood vessels or respiratory movement. The tissue circulation could be evaluated using fluorescence imaging of this system.
MMBS using the novel system is applicable to various surgeries and valuable for both fine surgical procedures and high-level surgical education.
使用传统光学显微镜或手术放大镜进行的显微手术具有有限的视野，并对手术医生造成严重的负担，尤其是在长时间手术中。在此，我们提倡使用新型高分辨率（4K）三维（3D）视频系统进行无微观和宏观边界手术（MMBS）。本研究旨在确认该概念在几种手术中的适用性。
我们在猪模型中进行了以下实验，以评估 MMBS 在以下实验中的可能用途和效果。实验 1（非劣效性检验）包括使用手术放大镜进行颈总动脉、门静脉、肝固有动脉的解剖和吻合，以及胰腺十二指肠切除术，与 MMBS 进行比较。实验 2（可行性检验）包括使用 MMBS 进行腹腔内和胸腔内较小动脉吻合，作为临床前设置。实验 3（新手术挑战）包括使用机器灌注维持的心脏死亡供体的原位肝移植。实验 2 中的心脏贴片和实验 3 中的肝移植物在保存期间的循环，通过配备该系统的吲哚菁绿荧光成像进行评估。
所有手术均通过 MMBS 完成。术者和助手可以在抬头状态下共享相同的视野。焦点深度足够深，不会受到搏动血管或呼吸运动的干扰。使用该系统的荧光成像可以评估组织循环。
使用新型系统的 MMBS 适用于各种手术，对于精细的手术操作和高水平的手术教育都具有价值。
