Inqubekelaphambili yokusetshenziswa kwama-exoscopes ezinkambisweni ze-neurosurgical

 

Ukusetshenziswa kwei-microscopes yokuhlinzwakanye nama-neuroendoscopes akuthuthukise ngokuphawulekayo ukusebenza ngempumelelo kwezinqubo zokuhlinza kwezinzwa, Noma kunjalo, ngenxa yezinye izici zemvelo zamathuluzi ngokwawo, anezingqinamba ezithile ekusetshenzisweni komtholampilo. ngokukhanya kokushiyeka kwei-microscopes esebenzayokanye nama-neuroendoscopes, okuhambisana nokuqhubekela phambili kwezithombe zedijithali, ukuxhumana kwenethiwekhi ye-Wifi, ubuchwepheshe besikrini nobuchwepheshe be-optical, uhlelo lwe-exoscope luye lwaba njengebhuloho phakathi kwama-microscopes okuhlinzwa kanye ne-neuroendoscopes. I-exoscope inomfanekiso ophakeme we-quaity kanye nenkundla yokubuka yokuhlinzwa, ukuma okungcono kwe-ergonomic, ukufundisa ngempumelelo kanye nokuzibandakanya kweqembu labahlinzeki ngokuphumelelayo, nokusebenza kwayo kokusetshenziswa kuyafana nalokho kwama-microscopes ane-strical. Njengamanje, izincwadi zibika ngokuyinhloko umehluko phakathi kwe-exoscopes kanye nama-microscopes okuhlinzwa ezicini ze-technicaequipment ezifana nokujula kwensimu, indawo ebonakalayo, ubude obugxilwe nokusebenza, okushodayo kanye nokuhlaziywa kwe-applcation ethize kanye nemiphumela yokuhlinzwa ye-exoscopes ku-neurosurgery, Ngakho-ke, sifingqa izinzuzo zabo eminyakeni yamuva nje ye-neurosurgery, i-neuroscourge. ukulinganiselwa ekusebenzeni komtholampilo, futhi unikeze izinkomba zokusetshenziswa kwe-cinical.

Umlando kanye Nokuthuthukiswa kwama-exoscopes

Izibonakhulu ezihlinzayo zinokukhanya okuhle kakhulu okujulile, inkambu yokuhlinza enesinqumo esiphezulu, kanye nemiphumela ye-imaging ye-stereoscopic, engasiza odokotela abahlinzayo babone ukwakheka kwezicubu ezijulile ze-neural kanye ne-vascular of the field yokuhlinzwa ngokucacile futhi bathuthukise ukunemba kokusebenza kwe-microscopic. Nokho, ukujula kwenkambu yeisibonakhulu sokuhlinzwaayijulile futhi indawo yokubuka incane, ikakhulukazi ekukhuliseni okuphezulu. Udokotela ohlinzayo udinga ukugxila ngokuphindaphindiwe futhi alungise i-angle yendawo ehlosiwe, enomthelela omkhulu esigqini sokuhlinzwa; Ngakolunye uhlangothi, udokotela ohlinzayo kudingeka abheke futhi asebenzise i-eyepiece yesibonakhulu, edinga udokotela ohlinzayo ukuba alondoloze ukuma okuqinile isikhathi eside, okungaholela kalula ekukhathaleni. Emashumini ambalwa eminyaka adlule, ukuhlinza okuncane kakhulu kuye kwathuthuka ngokushesha, futhi izinhlelo ze-neuroendoscopic ziye zasetshenziswa kabanzi ekuhlinzweni kwezinzwa ngenxa yezithombe zazo ezisezingeni eliphezulu, imiphumela engcono yomtholampilo, kanye nokwaneliseka okuphezulu kwesiguli. Kodwa-ke, ngenxa yomzila omncane wendlela ye-endoscopic kanye nokuba khona kwezakhiwo ezibalulekile ze-neurovascular eduze nesiteshi, kuhambisana nezici zokuhlinzwa kwe-cranial njengokungakwazi ukwandisa noma ukuncipha umgodi we-cranial, i-neuroendoscopy isetshenziselwa ikakhulukazi ukuhlinzwa kwesisekelo sogebhezi kanye nokuhlinzwa kwe-ventricular ngokusebenzisa amakhala kanye nezindlela zomlomo.

Njengoba kunikezwe ukushiyeka kwamamicroscopes okuhlinzwa kanye ne-neuroendoscopes, okuhambisana nentuthuko ekucabangeni kwedijithali, ukuxhumeka kwenethiwekhi ye-WiFi, ubuchwepheshe besikrini, nobuchwepheshe be-optical, uhlelo lwesibuko lwangaphandle luye lwavela njengebhuloho phakathi kwama-microscopes okuhlinzwa kanye ne-neuroendoscopes. Ngokufanayo ne-neuroendoscopy, isistimu yesibuko sangaphandle ngokuvamile iqukethe isibuko sokubona kude, umthombo wokukhanya, ikhamera enencazelo ephezulu, isikrini esibonisiwe, kanye nobakaki. Isakhiwo esiyinhloko esihlukanisa izibuko zangaphandle ku-neuroendoscopy isibuko sokubona kude esinobubanzi obungaba ngu-10 mm nobude obungaba ngu-140 mm. Ilensi yayo iku-engeli engu-0 ° noma engu-90 ° ku-eksisi ende yomzimba wesibuko, enobude obugxile ku-250-750 mm kanye nokujula kwenkambu engu-35-100 mm. Ubude bokugxila okude nokujula kwenkambu kuyizinzuzo ezibalulekile zezinhlelo zezibuko zangaphandle ngaphezu kwe-neuroendoscopy.

Ukuthuthuka kwesoftware kanye nobuchwepheshe behadiwe kukhuthaze ukuthuthukiswa kwezibuko zangaphandle, ikakhulukazi ukuvela kwezibuko zangaphandle ze-3D, kanye nezibuko zakamuva ze-3D 4K ze-ultra high definition zangaphandle. Uhlelo lwesibuko sangaphandle luvuselelwa njalo ngonyaka. Mayelana nesofthiwe, isistimu yesibuko yangaphandle ingakwazi ukubona ngeso lengqondo indawo yokuhlinza ngokuhlanganisa i-imaging yangaphambi kokuhlinzwa ye-magnetic resonance diffusion tensor, navigation intraoperative, kanye nolunye ulwazi, ngaleyo ndlela isize odokotela ukuba benze ukuhlinzwa okunembile nokuphephile. Ngokuphathelene ne-hardware, isibuko sangaphandle singahlanganisa i-5-aminolevulinic acid kanye nezihlungi ze-indocyanine ze-angiography, ingalo ye-pneumatic, isibambo sokusebenza esilungisekayo, ukuphuma kwesikrini esiningi, ibanga elide lokugxila kanye nokukhulisa okukhulu, ngaleyo ndlela kufinyelele imiphumela engcono yesithombe kanye nesipiliyoni sokusebenza.

Ukuqhathanisa phakathi kwe-exoscope nama-microscopes okuhlinzwa

Isistimu yesibuko sangaphandle ihlanganisa izici zangaphandle ze-neuroendoscopy nekhwalithi yesithombe samakroskopu okuhlinzwa, iphelelisana amandla nobuthakathaka bomunye nomunye, nokugcwalisa izikhala phakathi kwamamicroscopes okuhlinzwa kanye neuroendoscopy. Izibuko zangaphandle zinezici zokujula kwensimu kanye nenkundla yokubuka ebanzi (ububanzi bensimu yokuhlinzwa ka-50-150 mm, ukujula kwensimu engu-35-100 mm), ehlinzeka ngezimo ezilula kakhulu zokuhlinza okujulile ngaphansi kokukhulisa okuphezulu; Ngakolunye uhlangothi, ubude bokugxila kwesibuko sangaphandle bungafinyelela ku-250-750mm, bunikeze ibanga elide lokusebenza futhi kusize ukuhlinzwa kokuhlinzwa [7]. Mayelana nokubonwa kwezibuko zangaphandle, uRicciardi et al. kutholwe ngokuqhathanisa phakathi kwezibuko zangaphandle kanye nezibonakhulu zokuhlinzwa ukuthi izibuko zangaphandle zinekhwalithi yesithombe efanayo, amandla okubona, kanye nemiphumela yokukhulisa kuma-microscope. Isibuko sangaphandle singaphinde sishintshe ngokushesha sisuke kumbono we-microscopic siye kumbono we-macroscopic, kodwa lapho isiteshi sokuhlinza "siminyene phezulu futhi sibanzi phansi" noma sivinjwe ezinye izakhiwo zezicubu, inkambu yokubuka ngaphansi kwesibonakhulu ngokuvamile ilinganiselwe. Inzuzo yesistimu yesibuko yangaphandle ukuthi ingakwazi ukwenza ukuhlinzwa ngendlela ye-ergonomic eyengeziwe, ukunciphisa isikhathi esichithwa ukubuka insimu yokuhlinzwa nge-eyepiece yesibonakhulu, ngaleyo ndlela kunciphise ukukhathala kokuhlinzwa kukadokotela. Uhlelo lwesibuko lwangaphandle luhlinzeka ngekhwalithi efanayo yezithombe zokuhlinzwa ze-3D kubo bonke abahlanganyeli abahlinzayo phakathi nenqubo yokuhlinzwa. I-microscope ivumela abantu abangafika kwababili ukuthi basebenzise i-eyepiece, kuyilapho isibuko sangaphandle singabelana ngesithombe esifanayo ngesikhathi sangempela, sivumela odokotela abahlinzayo abaningi ukuba benze ukuhlinzwa ngesikhathi esisodwa futhi bathuthukise ukusebenza kahle kokuhlinzwa ngokwabelana ngolwazi nabo bonke abasebenzi. Ngesikhathi esifanayo, uhlelo lwesibuko lwangaphandle aluphazamisi ukuxhumana okuhlangene kweqembu elihlinzayo, okuvumela bonke abasebenzi abahlinzayo ukuba bahlanganyele ohlelweni lokuhlinzwa.

i-exoscope ekuhlinzeni kwe-neurosurgery

Uhambile et al. ibike izehlakalo ezingu-56 zokuhlinzwa kwe-glioma endoscopic, okuyisigameko esisodwa kuphela esinezinkinga (ukopha endaweni yokuhlinzwa) phakathi nenkathi yokuhlinzwa, ngezinga lesigameko elingu-1.8% kuphela. Rotermund et al. kubika amacala angu-239 okuhlinzwa kwe-transnasal transsphenoidal ye-pituitary adenomas, futhi ukuhlinzwa kwe-endoscopic akuzange kubangele izinkinga ezinkulu; Phakathi naleso sikhathi, awukho umehluko obalulekile ngesikhathi sokuhlinzwa, izinkinga, noma uhla lokuhlinza phakathi kokuhlinzwa kwe-endoscopic nokuhlinzwa okuncane kakhulu. U-Chen et al. ibike ukuthi izehlakalo ezingama-81 zamathumba zisuswe ngokuhlinzwa ngendlela ye-retrosigmoid sinus. Ngokwesikhathi sokuhlinzwa, izinga lokukhishwa kwesimila, ukusebenza kwezinzwa ngemva kokuhlinzwa, ukuzwa, njll., ukuhlinzwa kwe-endoscopic kwakufana nokuhlinzwa okuncane kakhulu. Uma kuqhathaniswa izinzuzo nezingozi zamasu amabili okuhlinza, isibuko sangaphandle sifana noma siphakeme kune-microscope ngokwekhwalithi yesithombe sevidiyo, inkambu yokubuka, ukusebenza, i-ergonomics, nokubamba iqhaza kweqembu labahlinzayo, kuyilapho umbono ojulile ulinganiswa njengokufana noma okungaphansi kwesibonakhulu.

i-exoscope ekufundiseni kwe-Neurosurgery

Enye yezinzuzo eziyinhloko zezibuko zangaphandle ukuthi zivumela bonke abasebenzi abahlinzayo ukuthi babelane ngekhwalithi efanayo yezithombe zokuhlinza ze-3D, okuvumela bonke abasebenzi abahlinzayo ukuba babambe iqhaza kakhulu enqubweni yokuhlinza, ukuxhumana nokudlulisa ulwazi lokuhlinzwa, ukwenza lula ukufundisa nokuqondiswa kokuhlinzwa kokuhlinzwa, ukwandisa ukuhlanganyela kokufundisa, nokuthuthukisa ukusebenza kahle kokufundisa. Ucwaningo luthole ukuthi uma kuqhathaniswa nezibonakhulu zokuhlinzwa, ijika lokufunda lezibuko zangaphandle lifushane kakhulu. Ekuqeqesheni elabhorethri yokuthunga, lapho abafundi nodokotela abahlala khona bethola ukuqeqeshwa kukho kokubili i-endoscope nesibonakhulu, abafundi abaningi bakuthola kulula ukusebenza nge-endoscope. Ekufundiseni ukuhlinzwa kokukhubazeka kwe-craniocervical, bonke abafundi babheke izakhiwo ze-anatomical ezinezinhlangothi ezintathu ngokusebenzisa izingilazi ze-3D, bathuthukisa ukuqonda kwabo kwe-craniocervical malformation anatomy, ukuthuthukisa umdlandla wabo wokuhlinza, futhi banciphise isikhathi sokuqeqesha.

I-Outlook

Nakuba uhlelo lwesibuko lwangaphandle lwenze inqubekelaphambili ebalulekile ekusetshenzisweni uma kuqhathaniswa nama-microscopes nama-neuroendoscopes, luphinde lube nemikhawulo yalo. Ukuhlehla okukhulu kwezibuko zangaphandle ze-2D zangaphambili kwakuwukuntuleka kombono we-stereoscopic ekukhuliseni izakhiwo ezijulile, okuthinte ukuhlinzwa nokwahlulela kodokotela abahlinzayo. Isibuko esisha sangaphandle se-3D sithuthukise inkinga yokuntuleka kombono we-stereoscopic, kodwa ezimweni ezingavamile, ukugqoka izibuko ze-polarized isikhathi eside kungabangela ukungakhululeki okufana nekhanda elibuhlungu kanye nesicanucanu kudokotela ohlinzayo, okugxilwe ekuthuthukisweni kwezobuchwepheshe esinyathelweni esilandelayo. Ngaphezu kwalokho, ekuhlinzeni i-endoscopic cranial, ngezinye izikhathi kuyadingeka ukushintshela kusibonakhulu ngesikhathi sokuhlinzwa ngoba ezinye izimila zidinga ukukhishwa okubukwayo okuqondiswa yi-fluorescence, noma ukujula kokukhanya kwenkundla yokuhlinzwa akwanele. Ngaphezu kwalokho, ekuhlinzeni i-endoscopic cranial, ngezinye izikhathi kuyadingeka ukushintshela kusibonakhulu ngesikhathi sokuhlinzwa ngoba ezinye izimila zidinga ukukhishwa okubukwayo okuqondiswa yi-fluorescence, noma ukujula kokukhanya kwenkundla yokuhlinzwa akwanele. Ngenxa yezindleko eziphezulu zemishini enezihlungi ezikhethekile, ama-endoscope e-fluorescence awakasetshenziswa kabanzi ekukhipheni isimila. Ngesikhathi sokuhlinzwa, umsizi umi endaweni ephambene nodokotela ohlinzayo oyinhloko, futhi ngezinye izikhathi ubona isithombe sokubonisa esijikelezayo. Kusetshenziswa izibonisi ze-3D ezimbili noma ngaphezulu, ulwazi lwesithombe sokuhlinzwa lucutshungulwa isofthiwe futhi luboniswe esikrinini somsizi ngefomu eliphendukile elingu-180 °, elingaxazulula ngempumelelo inkinga yokuzungezisa izithombe futhi livumele umsizi ukuba abambe iqhaza enqubweni yokuhlinza kalula.

Kafushane, ukusetshenziswa okwandayo kwezinhlelo ze-endoscopic ku-neurosurgery kumelela ukuqala kwenkathi entsha yokubonwa kwe-intraoperative ku-neurosurgery. Uma kuqhathaniswa nama-microscopes okuhlinzwa, izibuko zangaphandle zinekhwalithi engcono yesithombe kanye nenkundla yokubuka yokuhlinzwa, ukuma okungcono kwe-ergonomic ngesikhathi sokuhlinzwa, ukuphumelela kokufundisa okungcono, nokubamba iqhaza kweqembu elihlinzayo elisebenza kahle, elinemiphumela efanayo yokuhlinzwa. Ngakho-ke, ngokuhlinzwa okuvamile kwe-cranial nomgogodla, i-endoscope iyindlela entsha ephephile nesebenzayo. Ngokuthuthuka nokuthuthukiswa kobuchwepheshe, amathuluzi amaningi okubona ngeso lengqondo angasiza ekuhlinzeni ukuze kuzuzwe izinkinga eziphansi zokuhlinzwa kanye nokubikezelwa okungcono.