Availability of a Head-Mounted Display System in Endoscopic Skull Base Surgery

An endoscopic view usually provides us two-dimensional (2D) imagery while a three-dimensional (3D) image is ideal for performing surgical manipulation on the skull base as with most surgical microscopes. An endoscopy system with 3D imagery has been developed but it is not popular yet because of the expensive and limited choice of strabismus endoscopes for 3D image systems. Recently, the head-mounted display (HMD) system, a novel personalized image monitoring system, has been developed and used in a medical setting. We report here the availability of the HMD system in an endoscopic skull base surgery based on our investigative trials. As an advantage, a head-mounted monitor provides the sensation of immersion into the surgical field and a pseudo-3D effect to both surgeon and endoscope-holding assistant, especially while an endoscope is being moved. During surgical manipulation using a 3 or 4-handed technique by surgeon and assistant, they could perform their roles in comfortable head and body positions since the endoscopic imagery was in front of their eyes regardless of head position. In addition, when needed CT/MRI images of be superimposed on the head-mounted monitor view simply by using a foot switch. Many types of strabismus endoscopes were available for use with the HMD systems. On the other hand, skillful coordination among surgeon, assistant and scrub nurse was required since wearing the head-mounted device restricted the user from looking around. In addition, since a head-mounted device weighs 490 g, a decrease in device weight may be required for extended time usage. In conclusion, although more improvements are desirable, the HMD system is useful in endoscopic skull base surgery when surgical staff wish to perform their manipulations comfortably and with a 3D view of the surgical field.