Inkqubela phambili yokusetyenziswa kwe-exoscopes kwiinkqubo ze-neurosurgical

 

Ukusetyenziswa kweimikroskopu yotyandokunye ne-neuroendoscopes iphucule ngokubonakalayo ukusebenza kweenkqubo ze-neurosurgical, Nangona kunjalo, ngenxa yezinye iimpawu zendalo zesixhobo ngokwazo, zinemiqobo ethile kwizicelo zeklinikhi. Ukukhanya kweentsilelo zeiimicroscopes zokusebenzakunye ne-neuroendoscopes, kunye nokuqhubela phambili kwi-imaging yedijithali, uxhulumaniso lwenethiwekhi ye-Wifi, iteknoloji yesikrini kunye nobuchwepheshe be-optical, inkqubo ye-exoscope iye yaba njengebhulorho phakathi kwee-microscopes zokuhlinzwa kunye ne-neuroendoscopes. I-exoscope inomfanekiso ophezulu wequaity kunye nebala lokubonwayo lotyando, i-ergonomic posture engcono, impumelelo yokufundisa kunye nokuzibandakanya ngokufanelekileyo kweqela lotyando, kunye nokusebenza kwayo kufana noko kwe-microscopes yestrical. Okwangoku, uncwadi lunika ingxelo ngokungafaniyo phakathi kwe-exoscopes kunye ne-microscopes yotyando kwimiba ye-technicaequipment efana nobunzulu bentsimi, ibala lokubonwayo, ubude obugxilwe kunye nokusebenza, kunqongophala isishwankathelo kunye nohlalutyo lweziphumo ezithile zotyando lwe-exoscopes kwi-neurosurgery, ngenxa yoko, sishwankathela i-neurosurgery kwiminyaka yakutshanje, kwaye sishwankathela i-neurosurgery kwiminyaka yakutshanje. imida ekusebenzeni kweklinikhi, kwaye unikeze iireferensi zokusetyenziswa kwecinical.

Imbali kunye noPhuhliso lwe-exoscopes

Iimicroscopes zotyando zinokukhanya okugqwesileyo okugqwesileyo, indawo yokujonga ephezulu yotyando, kunye neziphumo zokucinga nge-stereoscopic, ezinokunceda oogqirha botyando baqwalasele ubume obunzulu be-neural kunye ne-vascular tissue yecandelo lotyando ngokucacileyo kwaye baphucule ukuchaneka kwemisebenzi emincinci. Nangona kunjalo, ubunzulu bentsimi yeImikroskopu yotyandoayinzulu kwaye indawo yokujonga imxinwa, ngakumbi kulwandiso oluphezulu. Ugqirha kufuneka agxininise ngokuphindaphindiweyo kwaye alungise i-angle yendawo ekujoliswe kuyo, enempembelelo enkulu kwisigqi sotyando; Kwelinye icala, ugqirha wotyando kufuneka ajonge kwaye asebenzise i-eyepiece ye-microscope, efuna ugqirha ukuba agcine i-posture esisigxina ixesha elide, nto leyo inokukhokelela ngokulula ekudinweni. Kwiminyaka embalwa edlulileyo, utyando oluncinci luye lwaphuhliswa ngokukhawuleza, kwaye iinkqubo ze-neuroendoscopic zisetyenziswe ngokubanzi kwi-neurosurgery ngenxa yemifanekiso yazo ephezulu, iziphumo ezingcono zekliniki, kunye nokwaneliseka okuphezulu kwesigulane. Nangona kunjalo, ngenxa yejelo elimxinwa lendlela ye-endoscopic kunye nobukho bezakhiwo ezibalulekileyo ze-neurovascular kufuphi netshaneli, kunye neempawu zotyando lwe-cranial ezifana nokungakwazi ukwandisa okanye ukucutha umngxuma we-cranial, i-neuroendoscopy isetyenziselwa ubukhulu becala utyando lwesiseko sokakayi kunye notyando lwe-ventricular ngokusebenzisa iimpumlo kunye neendlela zomlomo.

Ukunikezelwa kweentsilelo zeemicroscopes zotyando kunye ne-neuroendoscopes, kunye nenkqubela phambili kwi-imaging yedijithali, uqhagamshelwano lwenethiwekhi ye-WiFi, iteknoloji yesikrini, kunye nobuchwepheshe be-optical, inkqubo yesibuko sangaphandle iye yavela njengebhulorho phakathi kwee-microscopes zotyando kunye neuroendoscopes. Ngokufana ne-neuroendoscopy, inkqubo yesibuko yangaphandle ihlala inesipili sokubona kude, umthombo wokukhanya, ikhamera enenkcazo ephezulu, isikrini sokubonisa, kunye nesibiyeli. Isakhiwo esiphambili esahlula izibuko zangaphandle kwi-neuroendoscopy sisibuko sokujonga kude kunye nobubanzi obumalunga ne-10 mm kunye nobude obumalunga ne-140 mm. I-lens yayo ikwi-0 ° okanye i-90 ° engile ukuya kwi-axis ende yesipili somzimba, kunye noluhlu olugxininisekileyo lwe-250-750 mm kunye nobunzulu bentsimi ye-35-100 mm. Ubude bojoliso olude kunye nobunzulu bentsimi zezona zibonelelo ziphambili zeenkqubo zesipili zangaphandle ngaphezulu kwe-neuroendoscopy.

Ukuqhubela phambili kwesoftware kunye nobuchwepheshe be-hardware kukhuthaze uphuhliso lwezibuko zangaphandle, ngakumbi ukuvela kwezibuko zangaphandle ze-3D, kunye ne-3D 4K yamva nje ye-ultra high definition yezibuko zangaphandle. Inkqubo yesipili yangaphandle ihlaziywa rhoqo ngonyaka. Ngokwe-software, inkqubo yesipili yangaphandle inokubona indawo yotyando ngokudibanisa i-preoperative magnetic resonance diffusion tensor imaging, intraoperative navigation, kunye nolunye ulwazi, ngaloo ndlela inceda oogqirha ukuba benze utyando oluchanekileyo nolukhuselekileyo. Ngokumalunga ne-hardware, isibuko sangaphandle sinokudibanisa i-5-aminolevulinic acid kunye ne-indocyanine filters ze-angiography, ingalo ye-pneumatic, isibambo sokusebenza esilungelelanisiweyo, i-multiscreen output, umgama omde wokugxila kunye nokukhulisa okukhulu, ngaloo ndlela ufezekise iziphumo ezingcono zomfanekiso kunye namava okusebenza.

Ukuthelekisa phakathi kwe-exoscope kunye ne-microscopes yokuhlinzwa

Inkqubo yesipili yangaphandle idibanisa iimpawu zangaphandle ze-neuroendoscopy kunye nomgangatho womfanekiso we-microscopes yotyando, ukudibanisa amandla kunye nobuthathaka bomnye nomnye, kunye nokuzalisa izithuba phakathi kweemicroscopes zotyando kunye neuroendoscopy. Izibuko zangaphandle zineempawu zobunzulu obunzulu bentsimi kunye nombono obanzi (ububanzi bentsimi yotyando lwe-50-150 mm, ubunzulu bentsimi ye-35-100 mm), ukubonelela ngeemeko ezifanelekileyo kakhulu zokwenziwa kotyando olunzulu phantsi kokwandiswa okuphezulu; Ngakolunye uhlangothi, ubude obugxilwe kwisibuko sangaphandle bunokufikelela kwi-250-750mm, ukubonelela umgama omde wokusebenza kunye nokuququzelela utyando [7]. Ngokumalunga nokubonwa kwezibuko zangaphandle, uRicciardi et al. ifunyenwe ngokuthelekisa phakathi kwezibuko zangaphandle kunye neemicroscopes zotyando ukuba izibuko zangaphandle zinomgangatho womfanekiso ofanayo, amandla okukhanya, kunye nemiphumo yokwandisa kwiimicroscopes. Isibuko sangaphandle sinokutshintsha ngokukhawuleza ukusuka kumbono we-microscopic ukuya kwi-macroscopic, kodwa xa umjelo wotyando "uncinci phezulu kwaye ubanzi ezantsi" okanye uthintelwe ezinye izakhiwo zezicubu, intsimi yokujonga phantsi kwe-microscope idla ngokulinganiselwe. Inzuzo yenkqubo yesibuko yangaphandle kukuba inokwenza utyando kwi-ergonomic posture, ukunciphisa ixesha elichithwe ukujonga intsimi yotyando nge-eyepiece ye-microscope, ngaloo ndlela inciphisa ukudinwa kukagqirha. Inkqubo yesibuko yangaphandle ibonelela ngekhwalithi efanayo yemifanekiso yotyando ye-3D kubo bonke abathathi-nxaxheba botyando ngexesha lotyando. I-microscope ivumela abantu ababini ukuba basebenze nge-eyepiece, ngelixa isibuko sangaphandle sinokubelana ngomfanekiso ofanayo ngexesha langempela, ukuvumela oogqirha abaninzi ukuba benze utyando ngaxeshanye kunye nokuphucula ukusebenza kakuhle kotyando ngokwabelana ngolwazi nabo bonke abasebenzi. Ngexesha elifanayo, inkqubo yesibuko sangaphandle ayiphazamisi ukunxibelelana ngokubambisana kweqela lotyando, livumela bonke abasebenzi botyando ukuba bathathe inxaxheba kwinkqubo yotyando.

i-exoscope kutyando lwe-neurosurgery

Uhambile et al. kuxelwe iimeko ze-56 ze-glioma endoscopic utyando, apho kuphela imeko ye-1 yayineengxaki (igazi kwindawo yotyando) ngexesha le-perioperative, kunye nesantya se-1.8% kuphela. Rotermund et al. ingxelo yeemeko ze-239 ze-transnasal transsphenoidal operation ye-pituitary adenomas, kwaye utyando lwe-endoscopic aluzange lubangele iingxaki ezinzulu; Okwangoku, kwakungekho mmahluko obalulekileyo kwixesha lotyando, iingxaki, okanye uluhlu lokuhluthwa phakathi kotyando lwe-endoscopic kunye notyando lwe-microscopic. UChen et al. ingxelo ukuba 81 iimeko amathumba zaye zasuswa ngotyando ngokusebenzisa indlela retrosigmoid sinus. Ngokwexesha lotyando, iqondo lokususwa kwe-tumor, i-postoperative neurological function, ukuva, njl., utyando lwe-endoscopic lwalufana notyando lwe-microscopic. Ukuthelekisa iingenelo kunye nokungonakali kweendlela ezimbini zokuhlinzwa, isibuko sangaphandle siyafana okanye siphezulu kwi-microscope ngokubhekiselele kwikhwalithi yomfanekiso wevidiyo, intsimi yokujonga utyando, ukusebenza, i-ergonomics, kunye nokuthatha inxaxheba kweqela lotyando, ngelixa imbono enzulu ilinganiswa njengento efanayo okanye engaphantsi kwe-microscope.

i-exoscope kwi-Neurosurgery Teaching

Enye yeenzuzo eziphambili zezibuko zangaphandle kukuba zivumela bonke abasebenzi botyando ukuba babelane ngemifanekiso yotyando esemgangathweni efanayo ye-3D, evumela bonke abasebenzi botyando ukuba bathathe inxaxheba ngakumbi kwinkqubo yotyando, banxibelelane kwaye badlulisele ulwazi lotyando, baququzelele ukufundisa kunye nesikhokelo sotyando, bandise inxaxheba yokufundisa, kwaye baphucule impumelelo yokufundisa. Uphando lufumene ukuba xa kuthelekiswa nemicroscopes yotyando, ijika lokufunda lezibuko zangaphandle lifutshane. Kuqeqesho lwebhubhoratri ye-suturing, xa abafundi kunye noogqirha abahlala kuyo bafumana uqeqesho kwi-endoscope kunye ne-microscope, uninzi lwabafundi lukufumanisa kulula ukusebenza nge-endoscope. Ekufundiseni utyando lwe-craniocervical malformation, bonke abafundi baqaphela izakhiwo ze-anatomical ezine-dimensional ezintathu ngeeglasi ze-3D, bephucula ukuqonda kwabo kwe-craniocervical malformation anatomy, ukuphucula umdla wabo wokwenza utyando, kunye nokunciphisa ixesha loqeqesho.

Outlook

Nangona inkqubo yesipili yangaphandle yenze inkqubela phambili enkulu kwisicelo xa kuthelekiswa ne-microscopes kunye ne-neuroendoscopes, nayo inemida yayo. I-drawback enkulu ye-2D yezibuko zangaphandle ze-2D zangaphambili yayikukungabikho kombono we-stereoscopic ekukhuliseni izakhiwo ezinzulu, ezichaphazela imisebenzi yotyando kunye nokugweba kogqirha. Isibuko esitsha se-3D sangaphandle siye saphucula ingxaki yokungabikho kombono we-stereoscopic, kodwa kwiimeko ezinqabileyo, ukugqoka iiglasi ze-polarized ixesha elide kunokubangela ukungahambi kakuhle njengentloko kunye nesicaphucaphu kugqirha wotyando, eyona nto igxininise kuphuculo lobugcisa kwinqanaba elilandelayo. Ukongeza, kuqhaqho lwe-endoscopic cranial, ngamanye amaxesha kuyafuneka ukuba utshintshele kwi-microscope ngexesha lotyando kuba ezinye iithumba zifuna i-fluorescence ekhokelwa yi-resection ebonakalayo, okanye ubunzulu bokukhanya kwendawo yotyando akwanelanga. Ukongeza, kuqhaqho lwe-endoscopic cranial, ngamanye amaxesha kuyafuneka ukuba utshintshele kwi-microscope ngexesha lotyando kuba ezinye iithumba zifuna i-fluorescence ekhokelwa yi-resection ebonakalayo, okanye ubunzulu bokukhanya kwendawo yotyando akwanelanga. Ngenxa yeendleko eziphezulu zezixhobo ezinezihluzi ezikhethekileyo, ii-endoscopes ze-fluorescence azikasetyenziswa ngokubanzi ukukhutshwa kwethumba. Ngexesha lotyando, umncedisi umi kwindawo echasene nogqirha oyintloko, kwaye ngamanye amaxesha ubona umfanekiso ojikelezayo wokubonisa. Ukusebenzisa iziboniso ezimbini okanye ngaphezulu ze-3D, ulwazi lomfanekiso wokuhlinzwa lucutshungulwa yi-software kwaye luboniswe kwisikrini somncedisi kwifom ye-180 ° ephothiweyo, enokusombulula ngempumelelo ingxaki yokujikeleza komfanekiso kwaye yenza ukuba umncedisi athathe inxaxheba kwinkqubo yotyando ngokufanelekileyo.

Isishwankathelo, ukwanda kokusetyenziswa kweenkqubo ze-endoscopic kwi-neurosurgery kubonisa ukuqala kwexesha elitsha lokubonwa kwe-intraoperative kwi-neurosurgery. Xa kuthelekiswa ne-microscopes yokuhlinzwa, izibuko zangaphandle zinomgangatho ongcono womfanekiso kunye nentsimi yokujonga utyando, i-ergonomic posture engcono ngexesha lotyando, ukufundisa okungcono, kunye nokuthatha inxaxheba kweqela lotyando, kunye neziphumo ezifanayo zotyando. Ke ngoko, kuqhaqho oluqhelekileyo lwecranial kunye nomqolo, i-endoscope lukhetho olutsha olukhuselekileyo nolusebenzayo. Ngokuqhubela phambili kunye nophuhliso lwetekhnoloji, izixhobo ezingaphezulu zokubonwa kwe-intraoperative zinokuncedisa kwimisebenzi yotyando ukufezekisa iingxaki ezisezantsi zotyando kunye ne-prognosis engcono.