三维消化内镜研制及在活体动物内镜手术的初步应用（含视频）

Development of three‑dimensional digestive endoscope and the application to endoscopic submucosal dissection in living animals (with video)

摘要:

目的 研制三维（three‑dimensional，3D）消化内镜，并通过动物实验初步探讨用于胃部内镜黏膜下剥离术（endoscopic submuscular dissection，ESD）的效果和安全性。方法 荷兰小香猪2只，由郑州大学动物实验中心提供。ESD手术操作由2位高年资内镜医师完成，1人完成1例，一位术中佩戴3D眼镜，另一位术中佩戴3D高清头戴式显示器。记录ESD手术是否成功（手术步骤完成，拟定病灶全部剥离，术中及术后止血成功）、成功次数，有无穿孔、穿孔次数，术者（内镜医师及助手）术中立体感体验情况，术者术中、术后有无眼部不适症状（眼疲劳、眼痛、视物模糊），内镜医师对机械操作的信任度及内镜使用过程中存在的问题。结果 2例ESD均成功，无穿孔事件发生。术者反馈：术中3D消化内镜成像清晰，立体感强，进行内镜治疗时有明显的距离感和层次感，对出血点的判定更加精准，有2D图像无法比拟的层次感；术中及术后无眼部不适。内镜医师对3D消化内镜信任程度较高，但反映存在摄像头距离消化道管壁<10 mm时图像模糊的问题。结论 初步结果显示，3D消化内镜能够提供良好的立体成像，在活体动物的胃ESD操作过程中定位更加精准，安全性好，且不会明显增加术者的眼部不适，但存在摄像头与消化道管壁距离过近时的图像模糊尚待改进。

Abstract:

Objective To develop and evaluate the efficacy and safety of a three‑dimensional (3D) digestive endoscope for gastric endoscopic submucosal dissection (ESD) through animal experiments. Methods Two Dutch pigs were utilized from the Zhengzhou University Animal Experiment Center for the study. ESD procedures were performed by two senior endoscopists, one using 3D glasses and the other utilizing a 3D high-definition head display. The success of ESD was assessed based on predefined criteria, including completion of surgical steps, complete detachment of the presumptive lesion, and effective bleeding control during and after the surgery. The number of successful procedures and incidences of perforation were recorded. The stereoscopic experience of the endoscopists, including both the primary endoscopist and the assistant, was also evaluated. Furthermore, the assessment encompassed any reported symptoms of eye discomfort, such as eye fatigue, ocular pain, and blurred vision. Additionally, the confidence level of the endoscopists in the mechanical aspects of the operation, as well as encountered issues during the endoscopic procedures, were documented. Results Two ESD were successful and no perforation occurred. Feedback from endoscopists suggested that 3D digestive endoscopy offered clear images with enhanced three-dimensionality during surgery, clear sense of distance and layering, allowing for a precise judgment of bleeding points, which surpassed 2D capabilities. No eye discomfort was experienced by endoscopists or assistants during or after the procedures. While endoscopists exhibited high confidence in 3D digestive endoscopy, they noted issues with image blurring when the camera was positioned less than 10 mm from the gastrointestinal tract wall. Conclusion Preliminary results show that 3D digestive endoscopes can provide excellent stereo imaging, improved positioning accuracy, and safety during live animal stomach ESD procedures, without significantly increasing endoscopists'' eye discomfort. Nevertheless, efforts are needed to address image blurring concerns when the camera is close to the gastrointestinal tract wall.