Name: robot-assisted transcanal endoscopic ear surgery for congenital cholesteatoma
Uploaded: 2023-12-15T12:00:00
Description: Watch this Scientific Journal Video about Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma at JoVE.com

作者要感谢法国 Bagneux 的 Collin Medical 的支持，感谢 la Fondation des Gueules Cassées 帮助资助收购 Hôpital Necker - Enfants Malades， APHP 的 RobOtol。

这项研究是按照欧洲GDPR进行的，并在AP-HP，Hôpital Necker - Enfants Malades（编号20200727144143）注册。该研究遵循 CARE 指南12，父母双方都书面同意录制手术视频并发表病例报告13,14。手术策略反映了我们三级转诊中心通常使用的显微镜手术策略，涉及使用双手。主要区别在于手术方法，即经管，无需进行房门切开术或耳道成形术。
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<ol>
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这项研究报告了成功使用机器人辅助的全内窥镜手术切除一名 3 岁儿童的 III 期先天性胆脂瘤。全内窥镜耳部手术 （TEES） 在儿科人群中特别有趣，因为使用锁孔经管方法进行鼓室成形术可减少愈合时间和术后立即护理量。关于胆脂瘤手术，许多研究现在已经证明，与显微镜耳后或耳内入路相比，TEES 在特定患者中的残留率相似（如果不是更小的话）4,5,10</su...

先天性胆脂瘤 （CC） 占儿童胆脂瘤病例的 25%，近年来，由于公共卫生措施的改善和全球早期发现，其在胆脂瘤病例中的比例有所增加 1,2。CC 的大小和听骨受累对预后和手术策略有显著影响。因此，CC 可以根据 Potsic 分类3 进行分类。如果早期诊断，这些病变通常局限于鼓膜腔，或者可能延伸到具有完整基质的上膜，累及听小骨（Potsic III 期）或不累及听小骨（Potsic I 期或 II 期）。在更晚期的病例中，区分 CC 和获得性胆脂瘤可能具有挑战性，在上膜或乳突区域出现扩散性病变和鼓膜改变（Potsic IV 期）。
无乳突受累的 CC 患者（Potsic I 至 III 期）非常适合进行全内窥镜耳部手术 （TEES），该手术涉及最小的经管切口，并提供整个鼓室和上膜区域的良好视野。大量研究表明，与传统的显微方法相比，TEES产生相似的残差率4,5,6,7,8,9。TEES 已被全球许多儿科耳科中心采用，它提供了一种安全高效的技术，还增强了外科医生的人体工程学设计，使他们能够在面对屏幕时坐直 5,7,8,10。然而，在 TEES 期间，由于使用二手仪器时缺乏反稳定性，因此在 III 期病变中安全地解剖听小骨可能具有挑战性，从而增加了听小骨过度活动导致的听骨半脱位和内耳创伤的风险。此外，由于出血或内窥镜起雾，解剖过程中缺乏吸力会导致能见度差。专为中耳手术和人工耳蜗植入而设计的机械臂被用作机器人动态内窥镜支架，在整个手术过程中提供六个自由度，包括三个平移轴和三个旋转轴。在机器人辅助TEES期间的安全性已经在成年人群中报道过11。
本文报告了使用机器人辅助 TEES 治疗 3 岁儿童 III 期先天性胆脂瘤的机器人设置和外科手术。这种方法允许用两只手解剖胆脂瘤，同时受益于内窥镜观察和经管入路。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0&#176; 2.9 mm 25 cm Endoscope</td>
			<td>Collin</td>
			<td>RBT-END-0</td>
			<td>Endoscope for otoendoscopy</td>
		</tr>
		<tr>
			<td>Colorado MicroDissection Needle</td>
			<td>Stryker</td>
			<td></td>
			<td>Pointed electrocautery</td>
		</tr>
		<tr>
			<td>Facial nerve monitoring</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>RobOtol</td>
			<td>Collin</td>
			<td></td>
			<td>Robot dedicated to ear surgery</td>
		</tr>
		<tr>
			<td>Space mouse</td>
			<td>3DConnexion</td>
			<td></td>
			<td>RobOtol control arm</td>
		</tr>
		<tr>
			<td>Standard otology surgical material</td>
			<td></td>
			<td></td>
			<td>Including amongst standard instruments: speculum, Fisch dissectors</td>
		</tr>
	</tbody>
</table>

robot-assisted transcanal endoscopic ear surgery for congenital cholesteatoma

先天性胆脂瘤占儿童胆脂瘤病例的25%。经管内窥镜耳部手术 （TEES） 是这些患者的理想选择，因为它提供了中耳的宽内窥镜视野和微创方法。两个主要限制是年幼儿童失去一只手术手和狭窄的外耳道。在这里，我们介绍了一名 3 岁患者的病例，该患者患有 Potsic III 期先天性胆脂瘤，粘附在镫骨的砧骨和分支上。进行了机器人辅助 TEES 手术，在此期间，具有 6 个自由度的机械臂握住一个 0°、2.9 mm 宽的内窥镜，使外科医生能够用双手在狭窄的环境中工作。该过程的持续时间为 2 小时 9 分钟，其中包括 16 分钟的机械臂安装和悬垂。经管入路后，使用针（或镰刀）和抽吸从听小骨中解剖胆脂瘤，以稳定听小骨并限制听力创伤的风险。胆脂瘤被切除以减小其大小，使其能够被推到前踝下方，然后在切除前与其他粘附物分离。使用横骨软骨移植物加固鼓膜。

该案例研究报告了一名 3 岁儿童的 Potsic III 期左先天性胆脂瘤机器人辅助全内窥镜耳部手术 （TEES）。机械臂配备了一个 0° 和 30°、长 25 厘米、宽 2.9 毫米的示波器，连接到 1080p 全高清摄像头和屏幕。
术前检查显示典型的先天性胆脂瘤，CT扫描显示锤骨内侧有一个圆形的前肿块，向后延伸至镫骨间，向前延伸至输卵管上凹陷（图3）。听小骨链保持完整?...

Watch this Scientific Journal Video about Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma at JoVE.com

Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma

该协议描述了使用双手方法和机器人内窥镜支架的微创经管内窥镜耳部手术切除先天性胆脂瘤。

机器人辅助经管内窥镜耳部手术治疗先天性胆脂瘤

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because ...

该协议具有重要意义，因为它显示了在三岁儿童狭窄的耳道中采用双手内窥镜技术切除先天性胆脂瘤的可行性。先天性胆脂瘤可见于中耳腔。虽然没有骨侵蚀，但它从听小骨延伸到输卵管上凹陷。将内窥镜插入支架后，仔细检查患者的鼓膜。浸润耳道，防止凝血积聚。使用设置为低功率的倾斜烧灼针，沿鼓索向下、向后和向上打开鼓室，直到识别出踝颈。然后将鼓膜从鼓膜抬高，并将鼓膜口瓣向前推。使用钩子或针头将先天性胆脂瘤与砧骨和镫骨分离，然后用 Fisch 显微剖析器将其向前推到锤骨下方。现在，打开可控后下部的先天性胆脂瘤基质，用大吸力将其减大。从海角和踝骨解剖先天性胆脂瘤，并将其切除。使用倾斜的内窥镜检查鼓室。加固鼓膜并将软骨插入垫层位置，以防止随后的回缩袋。更换体管上的鼓膜瓣，并用可吸收的泡沫填充，从鼓膜的前部开始，以避免任何后续的侧向化。术前测听显示左耳传导性听力损失为10分贝，导致右耳与正常听力有轻微不对称。术后六周，左耳出现 10 分贝传导性听力损失，但值得注意的是，没有感音神经性听力损失。这种机器人技术为未来的研究铺平了道路，使机械臂与CT扫描上的3D映射同步，并开发增强现实。

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