Manuel Encarnacion Ramirez, Ismael Peralta Baez, Renat Nurmukhametov, Efgeni Goncharov, Ibrahim E Efe, Albert Sufianov, Issael Ramirez Pena
{"title":"Comparative survey study of the use of a low cost exoscope vs. microscope for anterior cervical discectomy and fusion (ACDF).","authors":"Manuel Encarnacion Ramirez, Ismael Peralta Baez, Renat Nurmukhametov, Efgeni Goncharov, Ibrahim E Efe, Albert Sufianov, Issael Ramirez Pena","doi":"10.3389/fmedt.2022.1055189","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) is an often performed procedure in spine neurosurgery. These are often performed using an operating microscope (OM) for better illumination and visualization. But its use is limited to the surgeon and the assistant. There is difficulty in maneuvering long surgical instruments due to the limited space available. Exoscope (EX) has been used as an alternative to microscopes and endoscopes. We used an EX in patients undergoing ACDF for cervical spondylotic myelopathy.</p><p><strong>Methods: </strong>A prospective comparative trial was conducted to test the safety and usability of a low-cost EX compared to a conventional surgical binocular OM in ACDF. Twenty-six patients with degenerative cervical myelopathy symptoms were operated by ACDF assisted by the EX and OM between December 2021 and June 2022. The authors collected and compared data on operative time, intraoperative hemorrhage, hospital admission, and complications in the two groups.</p><p><strong>Results: </strong>There were no statistically significant differences between the two groups in mean operative time, hospital stay, or postoperative complications. The average intraoperative blood loss was significantly more in the OM group. There were no surgical complications related to the use of the EX or OM. The comfort level, preoperative setup and intraoperative adjustment of position and angle of the EX were rated higher than the OM group. The image quality, depth perception, and illumination were rated as inferior to that of the OM. The low-cost EX was rated to be superior to that of the OM with regard to education and training purposes.</p><p><strong>Conclusion: </strong>Our study showed that the low-cost EX appears to be a safe and effective alternative for OM-assisted ACDF with great comfort and ergonomics and serves as an essential tool for education and training purposes. However, some limitations of our EX included slightly inferior image quality and illumination when compared with the OM.</p>","PeriodicalId":12599,"journal":{"name":"Frontiers in Medical Technology","volume":"4 ","pages":"1055189"},"PeriodicalIF":0.0000,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846206/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Medical Technology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3389/fmedt.2022.1055189","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) is an often performed procedure in spine neurosurgery. These are often performed using an operating microscope (OM) for better illumination and visualization. But its use is limited to the surgeon and the assistant. There is difficulty in maneuvering long surgical instruments due to the limited space available. Exoscope (EX) has been used as an alternative to microscopes and endoscopes. We used an EX in patients undergoing ACDF for cervical spondylotic myelopathy.
Methods: A prospective comparative trial was conducted to test the safety and usability of a low-cost EX compared to a conventional surgical binocular OM in ACDF. Twenty-six patients with degenerative cervical myelopathy symptoms were operated by ACDF assisted by the EX and OM between December 2021 and June 2022. The authors collected and compared data on operative time, intraoperative hemorrhage, hospital admission, and complications in the two groups.
Results: There were no statistically significant differences between the two groups in mean operative time, hospital stay, or postoperative complications. The average intraoperative blood loss was significantly more in the OM group. There were no surgical complications related to the use of the EX or OM. The comfort level, preoperative setup and intraoperative adjustment of position and angle of the EX were rated higher than the OM group. The image quality, depth perception, and illumination were rated as inferior to that of the OM. The low-cost EX was rated to be superior to that of the OM with regard to education and training purposes.
Conclusion: Our study showed that the low-cost EX appears to be a safe and effective alternative for OM-assisted ACDF with great comfort and ergonomics and serves as an essential tool for education and training purposes. However, some limitations of our EX included slightly inferior image quality and illumination when compared with the OM.
背景:颈椎前路椎间盘切除和融合术(ACDF)是脊柱神经外科经常实施的手术。这些手术通常使用手术显微镜(OM)进行,以获得更好的照明和可视化效果。但其使用仅限于外科医生和助手。由于空间有限,很难操作长的手术器械。外窥镜(EX)已被用作显微镜和内窥镜的替代品。我们在接受 ACDF 治疗颈椎病的患者中使用了 EX:我们进行了一项前瞻性比较试验,以测试低成本 EX 与传统手术双目 OM 相比,在 ACDF 中的安全性和可用性。在2021年12月至2022年6月期间,26名具有退行性颈椎脊髓病症状的患者在EX和OM的辅助下接受了ACDF手术。作者收集并比较了两组患者的手术时间、术中出血、入院时间和并发症等数据:结果:两组在平均手术时间、住院时间和术后并发症方面没有明显的统计学差异。OM组的术中平均失血量明显高于OM组。使用 EX 或 OM 均未出现手术并发症。EX组的舒适度、术前设置以及术中位置和角度调整均高于OM组。图像质量、深度感知和照明被评为不如 OM。在教育和培训方面,低成本 EX 被评为优于 OM:我们的研究表明,低成本 EX 似乎是 OM 辅助 ACDF 的一种安全有效的替代方法,具有极佳的舒适性和人体工学设计,是教育和培训的重要工具。然而,与 OM 相比,我们的 EX 存在一些局限性,包括图像质量和照明稍差。