The effect of three‐dimensional visualisation on performance in endoscopic sinus surgery: A clinical training study using surgical navigation for movement analysis in a randomised crossover design

Abstract

Objectives Endoscopic imaging techniques and endoscopic endonasal surgery (EES) expertise have evolved rapidly. Only few studies have assessed the effect of three‐dimensional (3D) endoscopy on endoscopic sinus surgery (ESS). The present study aimed to objectively and subjectively assess the additional value of 3D high‐definition (HD) endoscopy in ESS. Design A randomized crossover study of endoscopic surgery performance, using five ESS tasks of varying complexity, performed on Thiel embalmed human specimens. Setting Simulated surgical environment. Participants Thirty participants, inexperienced in ESS. Main outcome measures Performance was assessed using video imaging, surgical navigation and questionnaires. Main outcome measures were as follows: efficiency (defined by time to task completion), distance covered inside the nose, average velocity towards target, accuracy (measured by error rate), and subjective assessment of endoscope characteristics. Results During ESS tasks, both efficiency and accuracy did not differ significantly between 2D HD and 3D HD endoscopy. Subjectively, imaging characteristics of the 3D HD endoscope were rated significantly better. Conclusions ESS performance of inexperienced participants was not significantly improved by the use of 3D HD endoscopy during ESS tasks, although imaging characteristics of the 3D HD endoscope were rated significantly better. Surgical field characteristics and surgical techniques are likely to influence any additional value of 3D HD endoscopy.

Three‐Dimensional Endoscopic Endonasal Surgery: A Systematic Review

“…As such, these studies were classified as prospective randomized crossover trials. The tasks being used varied between studies, with the majority of studies reporting outcomes of multiple tasks; for example Ten Dam et al 21 assessed five different tasks with both endoscopes.…”

“…For the remaining aspects, the risk of bias was generally low, with the exception of selection and detection bias in Albrecht et al 22 The risk of bias for Ogino‐Nishimura et al 19 and Tabaee et al 25 was assessed differently to the other studies, as these were nonrandomized case series. No studies reported receiving funding, although Ten Dam et al 21 stated that they received nonfinancial support.…”

“…**Pooled total of the second attempts at cutting and biopsy tasks (see Fraser et al 20 task numbers 2 and 4 in Table III for further details). ***Pooled total the of identification, and grasping and retrieving tasks (see Ten Dam et al 21 task numbers 1, 3, 4, and 5 in Table III for further details). [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.…”

“…Fraser et al 20 and Ten Dam et al 21 reported data for additional two and four tasks, respectively. Pooling these found no significant difference between endoscopes, with a mean difference of less than 1 second (0.2 seconds, 95% CI: −1.7 to 2.1).…”

First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

“…Endoscopic-assisted endonasal surgery has been increasingly employed over the past two decades, and its development was mainly focused on providing better optics and improved instruments and accelerating the learning curve of young surgeons. In terms of visualization technologies, high-resolution image acquisition and 3D technology applied to the endoscopic vision have been developed [27,29]. Furthermore, in order to enhance the orientation during surgery the combination of navigation together with endoscopy is established; however, being limited to pointer navigation functionality during surgery.…”