Sulhan Suraj, Sellin Jonathan N
Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas.
Neurosurgical Group of Texas, Houston, Texas.
J Neurosurg Case Lessons. 2024 Sep 30;8(14). doi: 10.3171/CASE24318.
The prone transpsoas (PTP) technique involves the performance of a lateral lumbar interbody fusion with the patient prone. One challenge encountered in the early experience with the PTP technique is that with the patient in the prone position rather than the lateral decubitus position, the surgeon is often forced to raise the bed significantly and perform the interbody work in a hunched and seated position with their neck extended and shoulders abducted. The authors report on the use of a sterile retractor-mounted camera during PTP that allows for the surgery to be performed with surgical anatomy visualized on a heads-up display.
The PTP procedure is performed without significant modification from standard practice. After the self-retaining retractor is inserted, a sterile retractor-mounted camera can be introduced down one of the blades of the self-retaining retractor, preferably the dorsally situated blade to avoid camera line-of-sight issues with dependent irrigation or bleeding. The surgical field can now be visualized on a high-definition monitor, allowing the surgeon to stand at the patient's side instead of sitting.
A sterile retractor-mounted camera with a heads-up display is a novel way to address ergonomic challenges as well as improve educational opportunities in the operating room. https://thejns.org/doi/10.3171/CASE24318.
俯卧经腰大肌（PTP）技术是在患者俯卧位时进行腰椎侧方椎间融合术。PTP技术早期应用中遇到的一个挑战是，与侧卧位相比，患者处于俯卧位时，外科医生常常被迫大幅升高手术床，并在颈部伸展、肩部外展的弯腰坐姿下进行椎间融合操作。作者报告了在PTP手术中使用无菌牵开器安装摄像头的情况，该摄像头可使手术在平视显示器上可视化手术解剖结构的情况下进行。
PTP手术在操作上与标准术式相比并无显著改变。插入自动牵开器后，可将无菌牵开器安装摄像头经自动牵开器的一个叶片插入，最好是经位于背侧的叶片插入，以避免摄像头视线被冲洗液或出血遮挡的问题。现在手术视野可在高清监视器上显示，使外科医生能够站在患者身旁而非坐着操作。
带有平视显示器的无菌牵开器安装摄像头是一种解决人体工程学挑战以及改善手术室教学机会的新方法。https://thejns.org/doi/10.3171/CASE24318 。
