背景:脊柱内窥镜手术计划的成功实施取决于可靠的性能和病例成本,与传统的腰椎减压手术相似。
方法:为了提高常规腰椎内窥镜研究内窥镜耐久性的统计能力,作者通过社交媒体网络WhatsApp和微信上的电子邮件和聊天小组,对内窥镜脊柱外科医生进行了一项回顾性调查研究。对记录在多项选择题中的外科医生的回答进行描述性和相关统计。外科医生被问及脊柱内窥镜检查的临床经验,培训背景,他们通过入路进行腰椎内窥镜减压的类型,他们首选的减压仪器,以及他们对内窥镜设备故障的经验。
结果:共有485名外科医生做出了回应,其中85人提交了有效的调查记录,呈现27.1%的完成率。这85名受访者在过去一年中报告了12,650例腰椎内窥镜检查,到目前为止,在他们的集体职业生涯中,共进行了120,150次脊柱内窥镜检查。大多数受访者在医院环境中对椎间盘突出症(65.9%)和椎管狭窄(34.1%)进行了内窥镜手术,优先使用经孔(76.5%),层间(51.8%),和单侧双门静脉内镜(UBE;15.3%)入路技术。最常用的内窥镜脊柱系统是Wolf/RiwoSpine(38.8%),Joimax(36.5%),Storz(24.7%),未指定中国品牌(22.4%),Maxmore(15.3%),斯宾多(12.9%),Elliquence(10.6%),未指定韩国品牌(7.1%),和尽快EndosystemsGmbH(2.4%)。调查对象报告的内窥镜最常见的故障模式是图像模糊(71.8%),其次是焦点丧失(21.2%),手术部位的照明损失(18.8%),以及集成到内窥镜中的冲洗/抽吸系统的故障(4.7%)。大多数受访者认为他们的镜头有问题(67.1%),玻璃纤维光导体(23.5%),棱镜(16.5%),或杆系(4.7%)。据报道,电动高速动力毛刺和手动扩孔器和环钻是最受欢迎的减压工具,可能与内窥镜的故障有关。大多数受访者(49.5%)在必须更换或修理内窥镜之前进行了多达50次内窥镜检查。另有15.3%的受访者报告他们的内窥镜持续101至200例,只有12.9%的受访者报告超过300例。除了手术过程中的虐待(25.9%),员工处理不当是最常见的怀疑原因(45.9%),其次是错误的灭菌技术(21.2%)。约23.5%的受访者指出内窥镜在手术中失败。在这种情况下,66.3%要求更换内窥镜,36.1%的患者用破裂的内窥镜完成手术。然而,10.8%的受访者停止,另有6%的受访者将患者唤醒,并重新安排手术时间以在另一个时间完成减压。
结论:在腰椎间盘突出和椎管狭窄的常规腰椎减压手术中使用脊柱内窥镜的生命周期估计在50到100次手术之间。外科医生滥用药物,员工处理不当,以及规定的清洁和灭菌方案的偏差可能会大大缩短生命周期。应急方案应到位,以便在手术过程中轻松更换损坏的脊柱内窥镜。内窥镜脊柱手术技术的更全面实施将取决于技术进步,以使这些高科技手术器械更能抵抗日常使用的压力和滥用扩大的手术临床适应症。内窥镜制造商的监管负担可能会增加,呼吁增加对设施的报销,以支付资本设备购买的额外费用,一次性产品,和内窥镜脊柱手术程序的维护。
方法:3.
结论:最终用户外科医生调查研究。
BACKGROUND: Successful implementation of endoscopic spinal surgery programs hinges on reliable performance and case cost similar to traditional decompression surgeries of the lumbar spine.
METHODS: To improve the statistical power of studying the durability of endoscopes with routine lumbar endoscopy, the authors performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeon\'s responses recorded in multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, their preferred decompression instruments, and their experience with endoscopic equipment failure.
RESULTS: A total of 485 surgeons responded, of whom 85 submitted a valid survey recording, rendering a completion rate of 27.1%. These 85 respondents reported a case volume of 12,650 lumbar endoscopies within the past year and, to date, had performed a total of 120,150 spinal endoscopies over their collective career years. The majority of respondents performed endoscopic surgery for herniated disc (65.9%) vs spinal stenosis (34.1%) in a hospital setting, preferentially employing the transforaminal (76.5%), interlaminar (51.8%), and unilateral biportal endoscopic (UBE; 15.3%) approach technique. The most commonly used endoscopic spine systems were Wolf/Riwo Spine (38.8%), Joimax (36.5%), Storz (24.7%), unspecified Chinese brand (22.4%), Maxmore (15.3%), Spinendos (12.9%), Elliquence (10.6%), unspecified Korean brand (7.1%), and asap Endosystems GmbH (2.4%). The most frequent failure mode of the endoscope reported by survey respondents was a blurry image (71.8%), followed by the loss of focus (21.2%), the loss of illumination of the surgical site (18.8%), and the failure of the irrigation/suction system integrated into the endoscope (4.7%). Most respondents thought they had problems with the lens (67.1%), the fiberglass light conductor (23.5%), the prism (16.5%), or the rod system (4.7%). Motorized high-speed power burrs and hand reamers and trephines were the reported favorite decompression tools that were presumably associated with the endoscope\'s failure. The majority of respondents (49.5%) performed up to 50 endoscopies before the endoscope had to be either exchanged or repaired. Another 15.3% of respondents reported their endoscope lasted between 101 and 200 cases and only 12.9% reported more than 300 cases. Besides abuse during surgery (25.9%), bad handling by staff was the most common suspected reason (45.9%), followed by the wrong sterilization technique (21.2%). Some 23.5% of respondents noted that the endoscope failed during their surgery. In that case, 66.3% asked for a replacement endoscope, and 36.1% completed the surgery with the broken endoscope. However, 10.8% stopped and another 6% of respondents woke the patient up and rescheduled the surgery to complete the decompression at another time.
CONCLUSIONS: Spinal endoscopes used during routine lumbar decompression surgeries for herniated disc and spinal stenosis have an estimated life cycle between 50 and 100 surgeries. Abusive use by surgeons, mishandling by staff, and deviation for prescribed cleaning and sterilization protocols may substantially shorten the life cycle. Contingency protocols should be in place to readily replace a broken spinal endoscope during surgery. More comprehensive implementation of endoscopic spine surgery techniques will hinge on technology advancements to make these hightech surgical instruments more resistant to the stress of daily use and abuse of expanded clinical indications\' for surgery. The regulatory burden on endoscope makers is likely to increase, calling for increased reimbursement for facilities to cover the added expense for capital equipment purchase, disposables, and the endoscopic spine surgery program\'s maintenance.
METHODS: 3.
CONCLUSIONS: End user surgeon survey study.