Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China.
Orthop Surg. 2023 Jun;15(6):1556-1563. doi: 10.1111/os.13737. Epub 2023 May 8.
The risk of musculoskeletal injuries (MSIs) increases over years of practice which may lead to career-ending among surgeons. Exoscopes represent a new generation of imaging systems that help surgeons operate in a more comfortable posture. This article aimed to assess advantages and limitations, especially ergonomics with a 3D exoscope in lumbar spine microsurgery versus an operating microscope (OM) to reduce MSIs.
From March 2018 to May 2020, 90 patients with lumbar disc herniation undergoing a single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) procedure were included. Forty-seven patients were operated with the assistance of the exoscope and 43 patients were operated with the assistance of the OM. Clinical data, magnification, and illumination were evaluated. In particular, the ergonomics of surgeons was evaluated by a questionnaire (subjective) and a rapid entire body assessment (REBA; objective).
The postoperative outcomes were reasonably well balanced between the two groups. The handling of the exoscope was comparable to that of the OM. The depth perception, image quality, and illumination of the exoscope were inferior to those of the OM in MIS-TLIF with long and deep approaches. The educational and training function of the exoscope was superior to that of the OM. Importantly, surgeons rated the ergonomics of the exoscope as very high on the questionnaire and the REBA to the OM (P = 0.017).
This study showed that the exoscope was a safe and effective alternative to the OM for assisting the MIS-TLIF procedure with the unique advantage of ergonomics to reduce musculoskeletal injuries.
肌肉骨骼损伤 (MSI) 的风险随着从业年限的增加而增加，这可能导致外科医生职业生涯的终结。外窥镜代表了新一代成像系统，可帮助外科医生以更舒适的姿势进行手术。本文旨在评估在减少 MSI 方面，与传统手术显微镜（OM）相比，在腰椎微创手术中使用三维外窥镜的优势和局限性，特别是在人体工程学方面。
从 2018 年 3 月到 2020 年 5 月，共纳入 90 例接受单节段微创经椎间孔腰椎椎间融合术（MIS-TLIF）的腰椎间盘突出症患者。47 例患者在协助下使用外窥镜进行手术，43 例患者在协助下使用 OM 进行手术。评估了临床数据、放大率和照明。特别是，通过问卷调查（主观）和快速全身评估（REBA；客观）评估了外科医生的人体工程学。
两组患者的术后结果相当平衡。外窥镜的操作与 OM 相当。在长而深的入路的 MIS-TLIF 中，外窥镜的深度知觉、图像质量和照明效果不如 OM。外窥镜的教育和培训功能优于 OM。重要的是，外科医生在问卷调查和 REBA 中对外窥镜的人体工程学评价非常高，而对 OM 的评价则较低（P=0.017）。
本研究表明，外窥镜是 OM 辅助 MIS-TLIF 手术的一种安全有效的替代方法，具有独特的人体工程学优势，可以减少肌肉骨骼损伤。
