Frosolini Andrea, Benedetti Simone, Catarzi Lisa, Massarelli Olindo, Gennaro Paolo, Gabriele Guido
Maxillofacial Surgery Unit, Department of Medical Biotechnology, S. Maria alle Scotte University Hospital of Siena, 53100 Siena, Italy.
J Clin Med. 2024 Aug 23;13(17):4974. doi: 10.3390/jcm13174974.
The surgical treatment of lymphedema has seen advancements in recent years, with supramicrosurgical lymphaticovenular anastomosis (sLVA) gaining global acceptance. The integration of 3D exoscopes into microsurgery offers potential ergonomic and educational benefits. However, systematic evaluation of their efficacy in sLVA remains limited. A retrospective cross-sectional study was conducted comparing the use of 3D exoscopes to conventional operating microscopes (OM) in sLVA surgeries. Patient data from January 2019 to January 2024 were reviewed, with demographic, clinical, and surgical outcome variables analyzed. Ergonomic assessments were performed using Rapid Entire Body Assessment (REBA) and Rapid Upper Limb Assessment (RULA), while surgeon satisfaction was evaluated through the Microsurgical Intraoperative Satisfaction and Comfort questionnaire (MISCq). An analysis of 25 patients (OM group: = 14; exoscope group: = 11) revealed no significant differences in age, sex, etiology, or surgical site between the two groups. Surgical time, number of incisions, and number of anastomoses showed nonsignificant variations between the OM and exoscope groups. Ergonomic assessments indicated potential benefits with exoscope use, particularly for the assistant surgeon. Survey results demonstrated comparable levels of surgeon satisfaction with both instruments, with no significant differences in image quality, contrast, illumination, magnification, visual field, ergonomic maintenance, or stereoscopic orientation. The study suggests that 3D exoscopes are a valuable tool for sLVA supermicrosurgery, offering comparable outcomes to traditional microscopes with potential ergonomic advantages. Their integration into microsurgical practice may contribute to improved surgical comfort and team performance. Further research is warranted to confirm these findings and explore additional factors such as cost-effectiveness and long-term patient outcomes.
近年来，淋巴水肿的外科治疗取得了进展，超显微外科淋巴管静脉吻合术（sLVA）已获得全球认可。将3D外视镜集成到显微手术中具有潜在的人体工程学和教育优势。然而，对其在sLVA中的疗效进行系统评估仍然有限。进行了一项回顾性横断面研究，比较了3D外视镜与传统手术显微镜（OM）在sLVA手术中的使用情况。回顾了2019年1月至2024年1月的患者数据，分析了人口统计学、临床和手术结果变量。使用快速全身评估（REBA）和快速上肢评估（RULA）进行人体工程学评估，同时通过显微手术术中满意度和舒适度问卷（MISCq）评估外科医生的满意度。对25例患者（OM组：n = 14；外视镜组：n = 11）的分析显示，两组在年龄、性别、病因或手术部位方面无显著差异。手术时间、切口数量和吻合数量在OM组和外视镜组之间显示出无显著差异。人体工程学评估表明，使用外视镜有潜在益处，特别是对助手外科医生。调查结果表明，外科医生对两种仪器的满意度相当，在图像质量、对比度、照明、放大倍数、视野、人体工程学维护或立体定向方面无显著差异。该研究表明，3D外视镜是sLVA超显微手术的一种有价值的工具，其结果与传统显微镜相当，具有潜在的人体工程学优势。将其整合到显微手术实践中可能有助于提高手术舒适度和团队表现。有必要进行进一步研究以证实这些发现，并探索其他因素，如成本效益和患者长期预后。
