2D versus 3D Endoscopy: Head-to-Head Comparison in a Simulated Model of Endoscopic Endonasal Dural Suturing

Abstract

Objective Endonasal dural suturing (EDS) has been reported to decrease the incidence of cerebrospinal fluid fistula. This technique requires handling of single-shaft instrumentation in the narrow endonasal corridor. It has been proposed that three-dimensional (3D) endoscopes were associated with improved depth perception. In this study, we sought to perform a comparison of two-dimensional (2D) versus 3D endoscopy by assessing surgical proficiency in a simulated model of EDS.

Materials and Methods Twenty-six participants subdivided into groups based on previous endoscopic experience were asked to pass barbed sutures through preset targets with either 2D (Storz Hopkins II) or 3D (Storz TIPCAM) endoscopes on 3D-printed simulation model. Surgical precision and procedural time were measured. All participants completed a Likert scale questionnaire.

Results Novice, intermediate, and expert groups took 11.0, 8.7, and 5.7 minutes with 2D endoscopy and 10.9, 9.0, and 7.6 minutes with 3D endoscopy, respectively. The average deviation for novice, intermediate, and expert groups (mm) was 5.5, 4.4, and 4.3 with 2D and 6.6, 4.6, and 3.0 with 3D, respectively. No significant difference in procedural time or accuracy was found in 2D versus 3D endoscopy. 2D endoscopic visualization was preferred by the majority of expert/intermediate participants, while 3D endoscopic visualization by the novice group.

Conclusion In this pilot study, there was no statistical difference in procedural time or accuracy when utilizing 2D versus 3D endoscopes. While it is possible that widespread familiarity with 2D endoscopic equipment has biased this study, preliminary analysis suggests that 3D endoscopy offers no definitive advantage over 2D endoscopy in this simulated model of EDS.

Keywords

2D endoscope - 3D endoscope - dural suturing - 3D model - surgical simulator

Note

The abstract of the study was accepted as poster at the 31th North American Skull Base Society Annual Meeting (February 2021) and as an e-poster presentation at the AANS Annual Scientific Meeting (August, 2021, Orlando, Florida, United States).

Publication History

Received: 23 July 2021

Accepted: 21 September 2021

Article published online:
08 November 2021

• References

• 1 Oostra A, van Furth W, Georgalas C. Extended endoscopic endonasal skull base surgery: from the sella to the anterior and posterior cranial fossa. ANZ J Surg 2012; 82 (03) 122-130
• 2 Thomas R, Chacko AG. Principles in skull base reconstruction following expanded endoscopic approaches. J Neurol Surg B Skull Base 2016; 77 (04) 358-363
• 3 Pereira EAC, Grandidge CA, Nowak VA, Cudlip SA. Cerebrospinal fluid leaks after transsphenoidal surgery - effect of a polyethylene glycol hydrogel dural sealant. J Clin Neurosci 2017; 44: 6-10
• 4 Radovanovic I, Dehdashti AR, Turel MK. et al. Expanded endonasal endoscopic surgery in suprasellar craniopharyngiomas: a retrospective analysis of 43 surgeries including recurrent cases. Oper Neurosurg (Hagerstown) 2019; 17 (02) 132-142
• 5 Kim EH, Roh TH, Park HH, Moon JH, Hong JB, Kim SH. Direct suture technique of normal gland edge on the incised dura margin to repair the intraoperative cerebrospinal fluid leakage from the arachnoid recess during transsphenoidal pituitary tumor surgery. Neurosurgery 2015; 11 (Suppl. 02) 26-31 , discussion 31
• 6 Kizmazoglu C, Ozyoruk S, Husemoglu RB, Kalemci O, Sozer G, Sade B. Comparison of dural closure alternatives: an experimental study. Br J Neurosurg 2019; 33 (06) 655-658
• 7 Yamada S, Fukuhara N, Oyama K. et al. Surgical outcome in 90 patients with craniopharyngioma: an evaluation of transsphenoidal surgery. World Neurosurg 2010; 74 (2-3): 320-330
• 8 Horiguchi K, Nishioka H, Fukuhara N, Yamaguchi-Okada M, Yamada S. A new multilayer reconstruction using nasal septal flap combined with fascia graft dural suturing for high-flow cerebrospinal fluid leak after endoscopic endonasal surgery. Neurosurg Rev 2016; 39 (03) 419-427
• 9 Ahn JY, Kim SH. A new technique for dural suturing with fascia graft for cerebrospinal fluid leakage in transsphenoidal surgery. Neurosurgery 2009;65(6, Suppl):65–71, discussion 71–72
• 10 Felisati G, Pipolo C, Maccari A, Cardia A, Revay M, Lasio GB. Transnasal 3D endoscopic skull base surgery: questionnaire-based analysis of the learning curve in 52 procedures. Eur Arch Otorhinolaryngol 2013; 270 (08) 2249-2253
• 11 Ogino-Nishimura E, Nakagawa T, Sakamoto T, Ito J. Efficacy of three-dimensional endoscopy in endonasal surgery. Auris Nasus Larynx 2015; 42 (03) 203-207
• 12 Pennacchietti V, Garzaro M, Grottoli S. et al. Three-dimensional endoscopic endonasal approach and outcomes in sellar lesions: a single-center experience of 104 cases. World Neurosurg 2016; 89: 121-125
• 13 Roth J, Singh A, Nyquist G. et al. Three-dimensional and 2-dimensional endoscopic exposure of midline cranial base targets using expanded endonasal and transcranial approaches. Neurosurgery 2009; 65 (06) 1116-1128 , discussion 1128–1130
• 14 Uozumi Y, Taniguchi M, Nakai T, Kimura H, Umehara T, Kohmura E. Comparative evaluation of 3-dimensional high definition and 2-dimensional 4-K ultra-high definition endoscopy systems in endonasal skull base surgery. Oper Neurosurg (Hagerstown) 2020; 19 (03) 281-287
• 15 Uvelius E, Siesjö P. 3-D endoscopy in surgery of pituitary adenomas, prospective evaluation of patient gain using basic outcome parameters. J Clin Neurosci 2020; 76: 166-170
• 16 Barkhoudarian G, Del Carmen Becerra Romero A, Laws ER. Evaluation of the 3-dimensional endoscope in transsphenoidal surgery. Neurosurgery 2013;73(1, Suppl Operative):ons74–ons78, discussion ons78–ons79
• 17 Ergina PL, Cook JA, Blazeby JM. et al; Balliol Collaboration. Challenges in evaluating surgical innovation. Lancet 2009; 374 (9695): 1097-1104
• 18 Gulbins H, Boehm DH, Reichenspurner H, Arnold M, Ellgass R, Reichart B. 3D-visualization improves the dry-lab coronary anastomoses using the Zeus robotic system. Heart Surg Forum 1999; 2 (04) 318-324 , discussion 324–325
• 19 Becker H, Melzer A, Schurr MO, Buess G. 3-D video techniques in endoscopic surgery. Endosc Surg Allied Technol 1993; 1 (01) 40-46
• 20 Bickerton R, Nassimizadeh AK, Ahmed S. Three-dimensional endoscopy: the future of nasoendoscopic training. Laryngoscope 2019; 129 (06) 1280-1285
• 21 Brown SM, Tabaee A, Singh A, Schwartz TH, Anand VK. Three-dimensional endoscopic sinus surgery: feasibility and technical aspects. Otolaryngol Head Neck Surg 2008; 138 (03) 400-402
• 22 Kaufman Y, Sharon A, Klein O. et al. The three-dimensional “insect eye” laparoscopic imaging system-a prospective randomized study. Gynecol Surg 2007; 4 (01) 31-34
• 23 Nassimizadeh A, Zaidi SM, Nassimizadeh M, Kholief A, Ahmed SK. Endoscopic training-is the future three-dimensional?. Laryngoscope Investig Otolaryngol 2018; 3 (05) 345-348
• 24 Seong SY, Park SC, Chung HJ. et al. Clinical comparison of 3D endoscopic sinonasal surgery between ‘insect eye’ 3D and ‘twin lens’ 3D endoscopes. J Rhinol 2016; 23 (02) 102
• 25 Nebor I, Hossein A, Montemagno K. et al. Primary dural suturing via an endoscopic endonasal corridor: preliminary development of a 3D printed model for training. J Neurol Surg B Skull Base 2021; 3: 273-382
• 26 Lindquist NR, Leach M, Simpson MC, Antisdel JL. Evaluating simulator-based teaching methods for endoscopic sinus surgery. Ear Nose Throat J 2019; 98 (08) 490-495
• 27 Ishii M, Gallia GL. Application of technology for minimally invasive neurosurgery. Neurosurg Clin N Am 2010; 21 (04) 585-594 , v