İyi, kötü ve çirkin: Kulak cerrahisinde gün ışığı, kırmızı ve diğerleri
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Otolojik cerrahi uygulanan hastalarda beyaz ışığın kimi anatomik alanlarda veya patolojik lezyonları ayırt etmekte yetersiz kaldığı bilinmektedir. Farklı renkteki ışıklar altında dokuların görünürlüğü ışığın özelliklerinden ötürü farklı olmaktadır. Çalışmamızda otolojik cerrahi uygulanan hastaların beyaz ışık ile üç ana renkteki ışık olan mavi, yeşil ve kırmızı ışık altında uygulanan cerrahilerde cerrahi sahanın görünürlüğü açısından çeşitli farklılıklar olup olmadığının araştırılması amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif çalışmaya Nisan 2021- Mart 2023 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi Kulak Burun Boğaz Anabilim Dalı'nda herhangi bir otolojik patoloji nedeniyle opere edilen ve bu operasyon esnasında herhangi bir aşamada çift lümenli ileri düzey otoloji mikroskopu kullanılan, istenilen belirli kriterleri karşılayan 160 hasta dahil edilmiştir. Tüm demografik verilerine ulaşılabilen ve istenen ameliyat safhalarında en az 4 dalga boyundaki ışıkla (beyaz, mavi, yeşil, kırmızı renkli ışık) ekran görüntüleri alınmış olan hastaların operasyon görüntüleri bu operasyonu uygulayabilecek, yetkin ve çalışmaya hâkim beş ayrı kulak burun boğaz hastalıkları cerrahı tarafından skorlandı. Ardından bu skorlar kendisi içerisinde kıyaslanarak farklı ışıkların farklı alanlardaki skorları istatistiksel olarak karşılaştırıldı. Bulgular: Çalışmaya dahil edilen toplam 160 hastanın 88'i (%55) erkek, 72'si (%45) kadındı. Bu 160 hastanın; 118'i kolesteatomlu kronik otitis media tanısıyla opere edilen (Grup 1) , 14 hasta koklear implant cerrahisi geçiren (Grup 2), 12 hasta adheziv otitis media tanısıyla opere edilen (Grup 3), 3 hasta temporal kemik paragangliomu tanısıyla opere edilen (grup 4), 11 hasta periferik fasiyal paralizi tanısıyla opere edilen (Grup 5), ve 2 hasta aurikula cilt tümörü tanısı ile opere edilen hastalardan (Grup 6) oluşmaktaydı. Kolesteatomlu kronik otit hastalarında operasyon sonundaki inceleme esnasında beyaz ışıkla görülmeyen epitel dokusu kalıntısı 7 hastada yeşil ışık altında 5 hastada mavi ışık altında saptandı. (p<0.001) Adheziv otitis media tanılı hasta grubunda operasyon başındaki muayenede ve orta kulak yapıları ve epitel dokusu mavi ışık altındaki görsellerde beyaz ışığa göre istatistiksel olarak anlamlı derecede yüksek saptandı. (p<0.05) Orta kulak yapıları yeşil ışık altındaki görsellerde de skorlar beyaz ışığa göre istatistiksel olarak anlamlı derecede yüksek saptandı. Yeterli hasta sayısı bulunan gruplarda kırmızı ışık altındaki görsellerde tüm operasyon safhalarında beyaz ışığa göre anlamlı derecede daha kötü skorlar saptandı. (p<0.001) Sonuç: Gün ışığından esinlenerek cerrahi aydınlatmada sıklıkla kullanılan beyaz ışık tüm cerrahi işlemlerde yeterli olmayabilmektedir. Farklı renklerdeki ışıklar altında farklı yapıların daha iyi görülebileceği fikri tüm operasyonların tüm safhalarında standart bir ışık ile aydınlatma yapılması yerine her aşamaya ve her operasyona özgü farklı aydınlatma algoritmaları geliştirilebileceğini düşündürmektedir. Çalışmamızda varılan sonuçlar daha önceden az sayıda yayında da farklı yönleriyle bildirildiği gibi kırmızı ışığın elimine edildiği ışık tonlarında insan gözünün kimi operasyon safhalarında bazı yapıları detaylandırmada daha başarılı olabileceği sonucuna uygun bir sonuca varmıştır. Daha net veriler elde etmek için daha geniş ve farklı objektiflikte çalışmalar yapılması mantıklı olacaktır. Anahtar Kelimeler: Otolojik Cerrahi, Işık, Renk, Ameliyathane Mikroskobu, Kırmızı, Yeşil, Mavi
Introduction and Aim: It is known that white light is insufficient to distinguish some anatomical areas or pathological lesions in patients undergoing otologic surgery. Visibility of tissues under different colored lights is different due to the characteristics of the light. In our study, it was aimed to investigate whether there are various differences in the visibility of the surgical field in the surgeries performed under white light and the three main colors of light, blue, green and red. Materials and Methods: In this retrospective study, 160 patients who were operated for any otological pathology in Ege University Medical Faculty Hospital, Department of Otorhinolaryngology between April 2021 and March 2023 and using a double-lumen advanced otology microscope at any stage during this operation met the criteria were included. The operation images of the patients, whose demographic data could be accessed, and whose screen images were taken with at least 4 wavelengths of light (white, blue, green, red colored light) during the desired operation stages, were scored by five different competent otolaryngological surgeons. Then, these scores were compared within themselves and the scores of different lights in different areas were compared statistically. Results: Of the 160 patients included in the study, 88 (55%) were male and 72 (45%) were female. Of these 160 patients; 118 were operated with the diagnosis of chronic otitis media with cholesteatoma (Group 1), 14 patients underwent cochlear implant surgery (Group 2), 12 patients were operated with the diagnosis of adhesive otitis media (Group 3), 3 patients were operated with the diagnosis of temporal bone paraganglioma (Group 4), 11 patients were operated with the diagnosis of peripheral facial paralysis (Group 5) and 2 patients had auricular skin tumors (Group 6). In patients with chronic otitis media with cholesteatoma, epithelial tissue remnants that were not visible with white light were detected under green light in 7 patients and under blue light in 5 patients during the post-operative examination. (p<0.001) In the patient group diagnosed with adhesive otitis media, in the examination at the beginning of the operation and in the images under blue light, the middle ear structures and epithelial tissue were found to be statistically significantly higher than in white light. (p<0.05) The scores of middle ear structures under green light were also found to be statistically significantly higher than in white light. In the groups with sufficient number of patients, the visuals under red light had significantly worse scores than the white light in all operation phases. (p<0.001) Conclusion: Inspired by daylight, white light, which is frequently used in surgical lighting, may not be sufficient for all surgical procedures. The idea that different structures can be seen better under different colors of lights suggests that instead of using a standard light at all stages of all operations, different lighting algorithms specific to each stage and each operation can be developed. The results of our study have reached the conclusion that the human eye can be more successful in detailing some structures in some operational stages in light tones in which red light is eliminated, as previously reported in different aspects in a few publications. In order to obtain clearer data, it would be logical to conduct studies with wider and different objectivity. Keywords: Otologic Surgery, Light, Color, Operating Room Microscope, Red, Green, Blue
Introduction and Aim: It is known that white light is insufficient to distinguish some anatomical areas or pathological lesions in patients undergoing otologic surgery. Visibility of tissues under different colored lights is different due to the characteristics of the light. In our study, it was aimed to investigate whether there are various differences in the visibility of the surgical field in the surgeries performed under white light and the three main colors of light, blue, green and red. Materials and Methods: In this retrospective study, 160 patients who were operated for any otological pathology in Ege University Medical Faculty Hospital, Department of Otorhinolaryngology between April 2021 and March 2023 and using a double-lumen advanced otology microscope at any stage during this operation met the criteria were included. The operation images of the patients, whose demographic data could be accessed, and whose screen images were taken with at least 4 wavelengths of light (white, blue, green, red colored light) during the desired operation stages, were scored by five different competent otolaryngological surgeons. Then, these scores were compared within themselves and the scores of different lights in different areas were compared statistically. Results: Of the 160 patients included in the study, 88 (55%) were male and 72 (45%) were female. Of these 160 patients; 118 were operated with the diagnosis of chronic otitis media with cholesteatoma (Group 1), 14 patients underwent cochlear implant surgery (Group 2), 12 patients were operated with the diagnosis of adhesive otitis media (Group 3), 3 patients were operated with the diagnosis of temporal bone paraganglioma (Group 4), 11 patients were operated with the diagnosis of peripheral facial paralysis (Group 5) and 2 patients had auricular skin tumors (Group 6). In patients with chronic otitis media with cholesteatoma, epithelial tissue remnants that were not visible with white light were detected under green light in 7 patients and under blue light in 5 patients during the post-operative examination. (p<0.001) In the patient group diagnosed with adhesive otitis media, in the examination at the beginning of the operation and in the images under blue light, the middle ear structures and epithelial tissue were found to be statistically significantly higher than in white light. (p<0.05) The scores of middle ear structures under green light were also found to be statistically significantly higher than in white light. In the groups with sufficient number of patients, the visuals under red light had significantly worse scores than the white light in all operation phases. (p<0.001) Conclusion: Inspired by daylight, white light, which is frequently used in surgical lighting, may not be sufficient for all surgical procedures. The idea that different structures can be seen better under different colors of lights suggests that instead of using a standard light at all stages of all operations, different lighting algorithms specific to each stage and each operation can be developed. The results of our study have reached the conclusion that the human eye can be more successful in detailing some structures in some operational stages in light tones in which red light is eliminated, as previously reported in different aspects in a few publications. In order to obtain clearer data, it would be logical to conduct studies with wider and different objectivity. Keywords: Otologic Surgery, Light, Color, Operating Room Microscope, Red, Green, Blue
Açıklama
Anahtar Kelimeler
Kulak Burun ve Boğaz, Otorhinolaryngology (Ear-Nose-Throat), Otolojik Cerrahi, Işık, Renk, Ameliyathane Mikroskobu, Kırmızı, Yeşil, Mavi, Otologic Surgery, Light, Color, Operating Room Microscope, Red, Green, Blue
