The effect of three‐dimensional visualization on performance in endoscopic endonasal surgery: a clinical training study using surgical navigation for movement analysis in a randomized cross over design

The effect of three‐dimensional visualization on performance in endoscopic endonasal surgery: a clinical training study using surgical navigation for movement analysis in a randomized cross over 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 cross over 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 endoscopic endonasal surgery.

Main outcome measures

Performance was assessed using video imaging, surgical navigation and questionnaires, with the main outcome measures being 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 endoscopic sinus surgery 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.