Three-Dimensional High-Definition Neuroendoscopic Surgery: A Controlled Comparative Laboratory Study with Two-Dimensional Endoscopy and Clinical Application

Abstract

Background The purpose of this research was to investigate the usefulness of three-dimensional (3D) endoscopy compared with two-dimensional (2D) endoscopy in neuroendoscopic surgeries in a comparative study and to test the clinical applications.

Methods Forty-three examinees were divided into three groups according to their endoscopic experience: novice, beginner, or expert. Examinees performed three separate tasks using 3D and 2D endoscopy. A recently developed 3D high-definition (HD) neuroendoscope, 4.7 mm in diameter (Shinko Optical Co., Ltd., Tokyo, Japan) was used. In one of the three tasks, we developed a full-sized skull model of acrylic-based plastic using a 3D printer and a patient's thin slice computed tomography data, and evaluated the execution time and total path length of the tip of the pointer using an optical tracking system. Sixteen patients underwent endoscopic transnasal transsphenoidal pituitary surgery using both 3D and 2D endoscopy.

Results Horizontal motion was evaluated using task 1, and anteroposterior motion was evaluated with task 3. Execution time and total path length in task 3 using the 3D system in both novice and beginner groups were significantly shorter than with the 2D system (p < 0.05), although no significant difference between 2D and 3D systems in task 1 was seen. In both the novice and beginner groups, the 3D system was better for depth perception than horizontal motion. No difference was seen in the expert group in this regard. The 3D HD endoscope was used for the pituitary surgery and was found very useful to identify the spatial relationship of carotid arteries and bony structures.

Conclusions The use of a 3D neuroendoscope improved depth perception and task performance. Our results suggest that 3D endoscopes could shorten the learning curve of young neurosurgeons and play an important role in both general surgery and neurosurgery.

Keywords

three-dimensional high-definition endoscope - neuroendoscopic surgery - transsphenoidal surgery - laboratory investigation - depth perception

• References

• 1 Li KW, Nelson C, Suk I, Jallo GI. Neuroendoscopy: past, present, and future. Neurosurg Focus 2005; 19 (6) E1
• 2 Cappabianca P, Cavallo LM, Colao AM, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 2002; 97 (2) 293-298
• 3 Catalano MF, Van Dam J, Bedford R, Cothren RM, Sivak Jr MV. Preliminary evaluation of the prototype stereoscopic endoscope: precise three-dimensional measurement system. Gastrointest Endosc 1993; 39 (1) 23-28
• 4 Wenzl R, Lehner R, Vry U, Pateisky N, Sevelda P, Husslein P. Three-dimensional video-endoscopy: clinical use in gynaecological laparoscopy. Lancet 1994; 344 (8937) 1621-1622
• 5 Levy ML, Chen JCT, Moffitt K, Corber Z, McComb JG. Stereoscopic head-mounted display incorporated into microsurgical procedures: technical note. Neurosurgery 1998; 43 (2) 392-395 , discussion 395–396
• 6 Chen JCT, Levy ML, Corber Z, Assifi MM. Concurrent three dimensional neuroendoscopy: initial descriptions of application to clinical practice. Neurosurg Focus 1999; 6 (4) e12
• 7 Ohuchida K, Kenmotsu H, Yamamoto A , et al. The effect of CyberDome, a novel 3-dimensional dome-shaped display system, on laparoscopic procedures. Int J CARS 2009; 4 (2) 125-132
• 8 Taffinder N, Smith SGT, Huber J, Russell RC, Darzi A. The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons. Surg Endosc 1999; 13 (11) 1087-1092
• 9 Peitgen K, Walz MV, Walz MV, Holtmann G, Eigler FW. A prospective randomized experimental evaluation of three-dimensional imaging in laparoscopy. Gastrointest Endosc 1996; 44 (3) 262-267
• 10 Dion YM, Gaillard F. Visual integration of data and basic motor skills under laparoscopy. Influence of 2-D and 3-D video-camera systems. Surg Endosc 1997; 11 (10) 995-1000
• 11 van Bergen P, Kunert W, Bessell J, Buess GF. Comparative study of two-dimensional and three-dimensional vision systems for minimally invasive surgery. Surg Endosc 1998; 12 (7) 948-954
• 12 Falk V, Mintz D, Grünenfelder J, Fann JI, Burdon TA. Influence of three-dimensional vision on surgical telemanipulator performance. Surg Endosc 2001; 15 (11) 1282-1288
• 13 Chan ACW, Chung SCS, Yim AP, Lau JY, Ng EK, Li AK. Comparison of two-dimensional vs three-dimensional camera systems in laparoscopic surgery. Surg Endosc 1997; 11 (5) 438-440
• 14 Hanna GB, Shimi SM, Cuschieri A. Randomised study of influence of two-dimensional versus three-dimensional imaging on performance of laparoscopic cholecystectomy. Lancet 1998; 351 (9098) 248-251
• 15 Thomsen MN, Lang RD. An experimental comparison of 3-dimensional and 2-dimensional endoscopic systems in a model. Arthroscopy 2004; 20 (4) 419-423
• 16 Sun CC, Chiu AW, Chen KK, Chang LS. Assessment of a three-dimensional operating system with skill tests in a pelvic trainer. Urol Int 2000; 64 (3) 154-158
• 17 Mueller MD, Camartin C, Dreher E, Hänggi W. Three-dimensional laparoscopy. Gadget or progress? A randomized trial on the efficacy of three-dimensional laparoscopy. Surg Endosc 1999; 13 (5) 469-472
• 18 Herron DM, Lantis II JC, Maykel J, Basu C, Schwaitzberg SD. The 3-D monitor and head-mounted display. A quantitative evaluation of advanced laparoscopic viewing technologies. Surg Endosc 1999; 13 (8) 751-755
• 19 Tabaee A, Anand VK, Fraser JF, Brown SM, Singh A, Schwartz TH. Three-dimensional endoscopic pituitary surgery. Neurosurgery 2009; 64 (5) (Suppl. 02) 288-293 , discussion 294–295
• 20 Wasserzug O, Margalit N, Weizman N, Fliss DM, Gil Z. Utility of a three-dimensional endoscopic system in skull base surgery. Skull Base 2010; 20 (4) 223-228
• 21 Roth J, Fraser JF, Singh A, Bernardo A, Anand VK, Schwartz TH. Surgical approaches to the orbital apex: comparison of endoscopic endonasal and transcranial approaches using a novel 3D endoscope. Orbit 2011; 30 (1) 43-48
• 22 Shah RN, Leight WD, Patel MR , et al. A controlled laboratory and clinical evaluation of a three-dimensional endoscope for endonasal sinus and skull base surgery. Am J Rhinol Allergy 2011; 25 (3) 141-144
• 23 Kari E, Oyesiku NM, Dadashev V, Wise SK. Comparison of traditional 2-dimensional endoscopic pituitary surgery with new 3-dimensional endoscopic technology: intraoperative and early postoperative factors. Int Forum Allergy Rhinol 2012; 2 (1) 2-8
• 24 Castelnuovo P, Battaglia P, Turri-Zanoni M , et al. Transnasal skull base reconstruction using a 3-D endoscope: our first impressions. J Neurol Surg B 2012; 73 (2) 85-89
• 25 Fraser JF, Allen B, Anand VK, Schwartz TH. Three-dimensional neurostereoendoscopy: subjective and objective comparison to 2D. Minim Invasive Neurosurg 2009; 52 (1) 25-31
• 26 Feng C, Rozenblit JW, Hamilton AJ. A computerized assessment to compare the impact of standard, stereoscopic, and high-definition laparoscopic monitor displays on surgical technique. Surg Endosc 2010; 24 (11) 2743-2748
• 27 Hance J, Aggarwal R, Moorthy K, Munz Y, Undre S, Darzi A. Assessment of psychomotor skills acquisition during laparoscopic cholecystectomy courses. Am J Surg 2005; 190 (3) 507-511
• 28 Storz P, Buess GF, Kunert W, Kirschniak A. 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc 2012; 26 (5) 1454-1460
• 29 Tanoue K, Ieiri S, Konishi K , et al. Effectiveness of endoscopic surgery training for medical students using a virtual reality simulator versus a box trainer: a randomized controlled trial. Surg Endosc 2008; 22 (4) 985-990
• 30 Ieiri S, Nakatsuji T, Higashi M , et al. Effectiveness of basic endoscopic surgical skill training for pediatric surgeons. Pediatr Surg Int 2010; 26 (10) 947-954