Lin Hailin, Chen Fenyong, Mo Jiadong, Lin Taotao, Wang Zhenyu, Liu Wenge
Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, China.
World Neurosurg. 2022 May;161:e1-e7. doi: 10.1016/j.wneu.2021.07.033. Epub 2021 Jul 16.
The aim of this study was to evaluate our experience with a high-definition 3-dimensional (3D) exoscope (EX) for cervical spine surgery versus a binocular operating microscope (OM).
A retrospective review of patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) procedure for the treatment of cervical myelopathy from March 2019 to May 2020 was performed. Demographic, perioperative, and clinical outcomes of 50 patients were included, 23 of whom received assistance from the 3D exoscope (EX group) and 27 of whom received assistance from the OM (OM group). Operative baseline and postoperative outcome parameters were evaluated. Periprocedural handling, visualization, and illumination by the EX, as well as surgeons' ergonomics, were scored using a questionnaire and rapid upper limb assessment (RULA).
Baseline characteristics were similar between the 2 groups. There were no significant differences between groups in mean operative time, blood loss, duration of admission, or postoperative improvement of symptoms. Both groups showed similar clinical improvements after surgery. There were no intraoperative complications in either group. According to the attending surgeons, the intraoperative handling of instruments for the EX was rated to be comparable to that of the OM. Surgeons rated the comfort level of the intraoperative posture for the EX as very high on the subjective questionnaire and equal to the OM on the objective RULA. When compared with the OM, depth perception, image quality, and illumination for the EX were rated as inferior in ACDF procedures with long approaches. The operative education and training function of the EX was rated to be superior to that of the OM.
Overall, our study showed that the EX appears to be a safe alternative for common ACDF with the unique advantage of excellent comfort and also serves a useful educational tool for the surgical team. However, our investigation revealed several important limitations of this system, including slightly inferior visualization and illumination quality compared with the OM.
本研究旨在评估我们使用高清三维（3D）外视镜（EX）进行颈椎手术与双目手术显微镜（OM）的经验。
对2019年3月至2020年5月期间因治疗颈椎病而接受单节段前路颈椎间盘切除融合术（ACDF）的患者进行回顾性研究。纳入50例患者的人口统计学、围手术期和临床结果，其中23例接受3D外视镜辅助（EX组），27例接受手术显微镜辅助（OM组）。评估手术基线和术后结果参数。使用问卷和快速上肢评估（RULA）对EX的围手术期操作、可视化和照明以及外科医生的人体工程学进行评分。
两组的基线特征相似。两组在平均手术时间、失血量、住院时间或术后症状改善方面无显著差异。两组术后均有相似的临床改善。两组均无术中并发症。根据主刀医生的评价，EX的术中器械操作与OM相当。在主观问卷中，外科医生将EX术中姿势的舒适度评为非常高，在客观的RULA评分中与OM相当。与OM相比，在长入路的ACDF手术中，EX的深度感知、图像质量和照明被评为较差。EX的手术教育和培训功能被评为优于OM。
总体而言，我们的研究表明，EX似乎是常见ACDF手术的一种安全替代方案，具有极佳舒适度的独特优势，也是手术团队有用的教育工具。然而，我们的调查揭示了该系统的几个重要局限性，包括与OM相比，可视化和照明质量略差。
