Department of Neurosurgery, RUDN University, Moscow, Russia.
Department of Neurosurgery, Dr. Alejandro Cabral Hospital, San Juan, Dominican Republic.
World Neurosurg. 2022 Jul;163:5-10. doi: 10.1016/j.wneu.2022.03.144. Epub 2022 Apr 7.
Less than a quarter of the world population has access to microneurosurgical care within a range of 2 hours. We introduce a simplified exoscope system to achieve magnification, illumination, and video recording in low-resource settings.
We combined an industrial microscope tube, a heavy-duty support arm, a wide-field c-mount digital microscope camera, and a light-emitting diode ring light. All parts were sterilized with ethylene oxide. We performed 13 spinal and 3 cranial surgeries with the help of the low-budget exoscope.
The average preoperative setup time was 12.8 minutes. The exoscope provided similar magnification and illumination like a conventional binocular microscope. It allowed operating in a comfortable posture. The field of vision ranged from 30 mm-60 mm. The surgical field was captured by a 16-megapixel two-dimensional camera and projected to a 55-inch high-definition television screen in real time. Image quality was similar to that of a conventional microscope although our exoscope lacked stereoscopic view. Adjusting camera position and angle was time-consuming. Thus, the benefit of the exoscope was most notable in spine surgeries where the camera remained static for most of the time. The total cost of the exoscope was approximately U.S. $ 750.
Our low-budget exoscope offers similar image quality, magnification, and illumination like a conventional binocular microscope. It may thus help expand access to neurosurgical care worldwide. Users may face difficulty adapting to the lack of depth perception in the beginning. Prospective studies are needed to assess its usability and effectiveness compared to the microscope.
全球不到四分之一的人口能够在 2 小时车程内获得神经微创手术的服务。我们引入了一种简化的手术显微镜系统，旨在为资源匮乏环境提供放大、照明和视频记录功能。
我们将工业显微镜管、重型支撑臂、广角 C 型接口数字显微镜相机和发光二极管环形灯组合在一起。所有部件均采用环氧乙烷进行消毒。在该简化手术显微镜的帮助下，我们完成了 13 例脊柱手术和 3 例颅脑手术。
平均术前准备时间为 12.8 分钟。该手术显微镜提供了与传统双目显微镜相似的放大和照明效果。它允许手术医生以舒适的姿势进行操作。视野范围为 30-60 毫米。手术视野通过一个 1600 万像素的二维相机捕获，并实时投射到 55 英寸高清电视屏幕上。虽然我们的手术显微镜缺乏立体视觉，但图像质量与传统显微镜相似。调整相机位置和角度很耗时。因此，该手术显微镜的优势在脊柱手术中更为明显，因为相机在大多数时间保持静止。手术显微镜的总成本约为 750 美元。
我们的低成本手术显微镜提供了与传统双目显微镜相似的图像质量、放大倍数和照明效果。因此，它可能有助于扩大全球神经外科服务的可及性。使用者可能需要一些时间来适应缺乏深度感知的问题。需要进行前瞻性研究来评估其与显微镜相比的可用性和有效性。
