Three-dimensional Neurostereoendoscopy: Subjective and Objective Comparison to 2D

Abstract

Neuroendoscopic procedures, particularly transnasal skull-base procedures, are currently performed with 2D endoscopes that lack stereoscopic vision and depth of field. In principal, 3D vision should be preferable to the operating surgeon, but the previously existing systems have not been adopted. We evaluated a novel 3D endoscope to compare with 2D endoscopy. 33 neurosurgeons and skull-base otolaryngologists were recruited, and randomized to complete two runs of a task-based simulator paradigm using 2D and/or 3D visualization. After the two trials, each subject completed a questionnaire assessing professional demographics and preferences for visualization. The task paradigm had objective endpoints that measured speed, efficiency, and error rates. 75% of respondents preferred 3D endoscopy, and 87.5% determined that 3D visualization either somewhat or greatly helped with the assigned tasks. In the second run, subjects using 3D demonstrated a significantly higher efficiency than subjects using 2D (p=0.04). Subjects’ speed and efficiency improved significantly when moving from 2D to 3D, and speed and efficiency improved significantly from Run 1 to Run 2 for 3D visualization. Subjective and objective outcomes support the utility of 3D visualization for neuroendoscopic techniques. Visualization that provides real-time, high-resolution binocular depth perception has a role in endoscopic skull base surgery and other neuroendoscopic procedures.

3D - endonasal - endoscope - stereoendoscope - three-dimensional - transnasal - surgical simulators

References

• 1 Badani KK, Bhandari A, Tewari A. et al . Comparison of two-dimensional and three-dimensional suturing: is there a difference in a robotic surgery setting?.  J Endourol. 2005;  19 1212-1215
• 2 Taffinder N, Smith SG, Huber J. et al . The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons.  Surg Endosc. 1999;  13 1087-1092
• 3 Chen JC, Levy ML, Corber Z. et al . Concurrent three dimensional neuroendoscopy: initial descriptions of application to clinical practice.  Neurosurg Focus. 1999;  6 e12
• 4 Perez-Cruet MJ, Fessler RG, Perin NI. Review: complications of minimally invasive spinal surgery.  Neurosurgery. 2002;  51 S26-36
• 5 Tirakotai W, Bozinov O, Sure U. et al . The evolution of stereotactic guidance in neuroendoscopy.  Childs Nerv Syst. 2004;  20 790-795
• 6 Blavier A, Gaudissart Q, Cadiere GB. et al . Comparison of learning curves and skill transfer between classical and robotic laparoscopy according to the viewing conditions: implications for training.  Am J Surg. 2007;  194 115-121
• 7 Chan AC, Chung SC, Yim AP. et al . Comparison of two-dimensional vs. three-dimensional camera systems in laparoscopic surgery.  Surg Endosc. 1997;  11 438-440
• 8 Couldwell WT, Weiss MH, Rabb C. et al . Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases.  Neurosurgery. 2004;  55 539-547
• 9 Anand VK, Schwartz TH. Practical Endoscopic Skull Base Surgery. San Diego: Plural Publishing 2007
• 10 Cavallo LM, Messina A, Cappabianca P. et al . Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations.  Neurosurg Focus. 2005;  19 E2
• 11 Kassam A, Gardner P, Snyderman C. et al . Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa.  Neurosurg Focus. 2005;  19 E6
• 12 Kassam A, Snyderman CH, Mintz A. et al . Expanded endonasal approach: the rostrocaudal axis. Part 1. Crista galli to the sella turcica.  Neurosurg Focus. 2005;  19 E3
• 13 Kassam A, Snyderman CH, Mintz A. et al . Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum.  Neurosurg Focus. 2005;  19 E4
• 14 Jho HD, Ha HG. Endoscopic endonasal skull base surgery: part 1 – the midline anterior fossa skull base.  Minim Invas Neurosurg. 2004;  47 1-8
• 15 Jho HD, Ha HG. Endoscopic endonasal skull base surgery: part 2 – the cavernous sinus.  Minim Invas Neurosurg. 2004;  47 9-15
• 16 Jho HD, Ma H-G. Endosopic endonasal skull base surgery: part 3 – the clivus and posterior fossa.  Minim Invas Neurosurg. 2005;  47 16-23
• 17 Laufer I, Anand VK, Schwartz TH. Endonasal endoscopic extended transsphenoidal, transplanum approach for suprasellar lesions.  J Neurosurg. 2007;  106 400-406
• 18 Laufer I, Greenfield JP, Anand VK. et al . Endonasal endoscopic resection of the odontoid in a non-achondroplastic dwarf with juvenile rheumatoid arthritis. Feasibility of the approach and utility of intraoperative iso-C 3D navigation.  J Neurosurg. , [in press]
• 19 Frank G, Pasquini E, Doglietto F. et al . The endoscopic extended transsphenoidal approach for craniopharyngiomas.  Neurosurgery. 2006;  59 ONS75-ONS83
• 20 Schwartz TH, Fraser JF, Brown S. et al . Endoscopic skull base surgery. Classification of operative approaches.  Neurosurgery. , [in press]
• 21 Wong GK, Zhu CX, Ahuja AT. et al . Craniotomy and clipping of intracranial aneurysm in a stereoscopic virtual reality environment.  Neurosurgery. 2007;  61 564-568 , discussion 568–569
• 22 Anil SM, Kato Y, Hayakawa M. et al . Virtual 3-dimensional preoperative planning with the dextroscope for excision of a 4th ventricular ependymoma.  Minim Invasive Neurosurg. 2007;  50 65-70
• 23 Levy ML, Chen JC, Moffitt K. et al . Stereoscopic head-mounted display incorporated into microsurgical procedures: technical note.  Neurosurgery. 1998;  43 392-395 , discussion 395–396
• 24 Votanopoulos K, Brunicardi FC, Thornby J. et al . Impact of three-dimensional vision in laparoscopic training.  World J Surg. 2008;  32 110-118
• 25 Brown S TA, Singh A, Schwartz TH. et al . Three-dimensional endoscopic sinus surgery: feasibility and technical aspects.  Otolaryngology and Head and Neck Surgery. 2008;  , [in press]

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