The User Experience on a 3-Dimensional Heads-Up Display for Vitreoretinal Surgery Across All Members of the Health Care Team: A Survey of Medical Students, Residents, Fellows, Attending Surgeons, Nurses, and Anesthesiologists

Abstract

Purpose: This work assesses the educational use of a 3-dimensional (3D) heads-up visualization system for vitreoretinal surgery. Methods: A cross-sectional survey was performed among 18 medical students, 18 residents, 7 VR fellows, 6 nurses, 4 anesthesiologists, and 3 surgeons on their experience with the Ngenuity 3D Visualization System (TrueVision and Alcon) compared with the standard microscope. Results: Most medical students (88%) reported better identification of surgical landmarks; 63% ranked the Ngenuity as their preferred method of learning (vs microscope or 2-dimensional display). Residents reported a superior understanding of anatomy (69%), an increased ability to ask questions (63%), and improved ergonomics (94%). Epiretinal membrane peel, internal limiting membrane peel, and core vitrectomy were most enhanced (69% to 77%) for residents. Fellows’ experience with trocar placement, vitrectomy, and oil/gas insertion was the same as before (67% to 100%), whereas endolaser and closing were worse (67% to 100%). Regarding autonomy, 83% of fellows reported no change, whereas 17% reported increased levels. Nurses were better able to track case progress (67%) and anticipate which tools were needed (50%). All anesthesiologists reported the same or worse engagement in cases, noting it was difficult to switch between the 3D screen and the anesthesia equipment. All surgeons reported a better awareness of trainees in the room and an improved ability to point out landmarks; 67% reported being more comfortable with resident and fellow autonomy. Conclusions: The Ngenuity is most helpful to students and residents. Integrating 3D displays into the surgical curriculum is beneficial, with care to ensure nurse and anesthesiologist satisfaction.

Comparison of the Safety and Efficacy of a 3-Dimensional Heads-up Display vs a Standard Operating Microscope in Retinal Detachment Repair

“…4 Furthermore, the unified view enhances the trainee and learner experience in the operating room. 3,[5][6][7] Last, the 3D HUD system can positively affect patient outcomes in vitreoretinal surgery because it potentially allows surgeons to use a lower amount of endoillumination, thus decreasing lightinduced damage to neural and retinal pigment epithelium cells. 2,8 Although there are advantages to the HUD system, there is an associated learning curve, which may deter some ophthalmologists from adopting its use.…”

Heads-Up Three-Dimensional Viewing Systems in Vitreoretinal Surgery: An Updated Perspective

“…36 In a cross-sectional survey, most medical students reported higher accuracy in identifying the anatomy with the 3D head-up viewing system NGENUITY ® , and they preferred this platform over the 2-dimensional display and standard microscopy as their desired learning modality. 37 Likely, medical students who work with a surgeon who uses 3D heads-up visualization systems have a more positive experience in the operating room as they can better visualize the steps of the intraocular procedure. Residents also reported greater anatomical knowledge and improved ergonomics with the 3D heads-up system.…”

“…Residents also reported greater anatomical knowledge and improved ergonomics with the 3D heads-up system. 37 It was also reported that the operation room nurses had an enhanced ability to monitor the case development and foresee which tools might be required. 37 This could potentially lead to reduced operating times and minimize errors.…”

Feasibility and Potential for Real-Time 3D Vitreoretinal Surgery Telementoring

“…Modernization of the surgical microscope with a digital three-dimensional (3D) surgical display was developed as a solution, giving trainees an identical viewing experience as the operating surgeon. 2…”

“…Modernization of the surgical microscope with a digital threedimensional (3D) surgical display was developed as a solution, giving trainees an identical viewing experience as the operating surgeon. 2 The 3D visualization system uses a high dynamic range (HDR) camera with a 4K monitor, resulting in an equivalent replacement to the optical microscope with the added benefits of a digital system such as lower illumination levels, 3 improved depth of field, 4 reduced retinal toxicity for patients, 5 and use of display filters and image manipulation to augment and improve surgical performance. 6 In addition, the improved ergonomics of the heads-up display help reduce back and neck stress for the operating surgeon.…”