背景:最近开发了外射镜,可替代手术显微镜(OM)和内窥镜,用于神经外科手术中的可视化。先前的综述研究了混合的颅骨和脊柱手术队列报告了使用外镜检查的优势,包括改进的人体工程学和教学。近年来,出镜研究有所增加,没有更新的系统评价仅集中在脊柱手术中的外镜检查的益处和局限性。
目的:系统综合与外镜辅助脊柱手术相关的文献。
方法:使用PubMed进行了文献检索,Embase,Scopus,科克伦,和WebofScience数据库,以确定2010年至2023年9月之间发表的相关研究。数据,例如使用的外镜模型,执行的程序类型,和用户观察,然后收集。
结果:31项研究符合我们的纳入标准。481名患有脊柱病变的患者使用九种外镜模型之一进行了外科手术。最常进行腰椎手术(N=234;48.6%),椎间盘切除术占大多数整体手术(N=273;56.8%)。所有患者临床受益。与OMs或内窥镜相比,外镜的报告优势在于改善了焦距,外科医生的姿势,见习教育,紧密度,助理参与。其他方面,如立体视觉,照明,和成本有不同的观察。
结论:在脊柱手术中,与OMs或内窥镜相比,外切镜具有优势。用户学习曲线是最小的,并且没有负面的患者结局报告。尽管如此,在可以将外镜视为术中可视化策略的标准设备之前,外镜使用的某些方面需要进行长期的前瞻性研究。
Exoscopes were recently developed as an alternative to the operative microscope (OM) and endoscope for intraoperative visualization during neurosurgery. Prior reviews studying mixed cranial and spinal surgical cohorts reported advantages with
exoscope use, including improved ergonomics and teaching. In recent years, there has been an increase in
exoscope research, with no updated systematic
review focused exclusively on the benefits and limitations of
exoscope use in spine surgery. Thus, we sought to systematically synthesize the literature related to
exoscope-assisted spine surgery.
A literature search was conducted using the PubMed, Embase, Scopus, Cochrane, and Web of Science databases to identify relevant studies reported between 2010 and September 2023. Data, such as the exoscope model used, procedure types performed, and user observations, were then collected.
A total of 31 studies met our inclusion criteria, including 481 patients with spine pathologies who underwent a surgical procedure using 1 of 9 exoscope models. The lumbar region was the most frequently operated area (n = 234; 48.6%), and discectomies comprised the most overall procedures (n = 273; 56.8%). All patients benefited clinically. The reported advantages of exoscopes compared with OMs or endoscopes were improved focal distance, surgeon posture, trainee education, compactness, and assistant participation. Other aspects such as stereopsis, illumination, and cost had various observations.
Exoscopes have advantages compared with OMs or endoscopes during spine surgery. The user learning curve is minimal, and no negative patient outcomes have been reported. However, some aspects of
exoscope use necessitate longer term prospective research before exoscopes can be considered a standard tool in the armamentarium of intraoperative visualization strategies.