1
|
Ban Y, Mcneely B, Chadha NK, Felton M. Safety and efficacy of three-dimensional versus two-dimensional endoscopy in otolaryngology surgery and training: A systematic review. Clin Otolaryngol 2024. [PMID: 38735751 DOI: 10.1111/coa.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/24/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Three-dimensional (3D) endoscopy has been developed to provide depth perception to allow for improved visualisation during otolaryngology surgery. We conducted a systematic review to determine the surgical safety and efficacy of 3D endoscopy in comparison to two-dimensional (2D) endoscopy in performing otolaryngology procedures, and the role of 3D endoscopy as a training tool for novice otolaryngology surgeons. METHODS Primary studies were identified through MEDLINE, Embase and Web of Science databases, which were searched for articles published through June 2022 that compared the outcomes of 2D and 3D endoscopy in otolaryngology surgical procedures or otolaryngology-relevant simulations. Candidate articles were independently reviewed by two authors. RESULTS A total of 18 full-text articles met inclusion criteria for this study. In clinical trials (n = 8 studies, 362 subjects), there were no significant differences in performance time, intraoperative or postoperative complications with 3D endoscopes when compared to 2D. In simulation studies (n = 10 studies, 336 participants), 3D endoscopes demonstrated a decreased error rate (n = 5 studies) and shorter performance time (n = 3 studies). Studies also reported improved depth perception (n = 14 studies) and visualisation preference (n = 5 studies) with 3D over 2D systems. The 3D systems were found to have a shorter learning curve and better manoeuvrability among novice surgeons. CONCLUSION 3D endoscopy showed equivalent safety and efficacy compared to 2D endoscopy in otolaryngology surgery. The improved depth perception and performance for novices using 3D endoscopes suggests the technology may be superior to 2D endoscopes as a training tool for otolaryngology surgeons.
Collapse
Affiliation(s)
- Yuxin Ban
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Brendan Mcneely
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Neil K Chadha
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Mark Felton
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Khan DZ, Hanrahan JG, Baldeweg SE, Dorward NL, Stoyanov D, Marcus HJ. Current and Future Advances in Surgical Therapy for Pituitary Adenoma. Endocr Rev 2023; 44:947-959. [PMID: 37207359 PMCID: PMC10502574 DOI: 10.1210/endrev/bnad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/14/2023] [Accepted: 05/17/2023] [Indexed: 05/21/2023]
Abstract
The vital physiological role of the pituitary gland, alongside its proximity to critical neurovascular structures, means that pituitary adenomas can cause significant morbidity or mortality. While enormous advancements have been made in the surgical care of pituitary adenomas, numerous challenges remain, such as treatment failure and recurrence. To meet these clinical challenges, there has been an enormous expansion of novel medical technologies (eg, endoscopy, advanced imaging, artificial intelligence). These innovations have the potential to benefit each step of the patient's journey, and ultimately, drive improved outcomes. Earlier and more accurate diagnosis addresses this in part. Analysis of novel patient data sets, such as automated facial analysis or natural language processing of medical records holds potential in achieving an earlier diagnosis. After diagnosis, treatment decision-making and planning will benefit from radiomics and multimodal machine learning models. Surgical safety and effectiveness will be transformed by smart simulation methods for trainees. Next-generation imaging techniques and augmented reality will enhance surgical planning and intraoperative navigation. Similarly, surgical abilities will be augmented by the future operative armamentarium, including advanced optical devices, smart instruments, and surgical robotics. Intraoperative support to surgical team members will benefit from a data science approach, utilizing machine learning analysis of operative videos to improve patient safety and orientate team members to a common workflow. Postoperatively, neural networks leveraging multimodal datasets will allow early detection of individuals at risk of complications and assist in the prediction of treatment failure, thus supporting patient-specific discharge and monitoring protocols. While these advancements in pituitary surgery hold promise to enhance the quality of care, clinicians must be the gatekeepers of the translation of such technologies, ensuring systematic assessment of risk and benefit prior to clinical implementation. In doing so, the synergy between these innovations can be leveraged to drive improved outcomes for patients of the future.
Collapse
Affiliation(s)
- Danyal Z Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- Centre for Obesity and Metabolism, Department of Experimental and Translational Medicine, Division of Medicine, University College London, London WC1E 6BT, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
- Digital Surgery Ltd, Medtronic, London WD18 8WW, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| |
Collapse
|
3
|
Micko ASG, Cho A, Heck S, Marik W, Wolfsberger S. Does High-Definition 3-Dimensional Imaging Improve Orientation During Endoscopic Transsphenoidal Surgery? A Prospective Trial. Oper Neurosurg (Hagerstown) 2022; 24:e330-e335. [PMID: 36701670 DOI: 10.1227/ons.0000000000000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Endoscopy has evolved as the standard visualization tool for endonasal transsphenoidal resection of sellar lesions. The most widely used 2-dimensional (2D) endoscopes harbor the problem of limited depth perception. Therefore, 3-dimensional (3D) endoscopes have been developed to enable depth perception through a stereoscopic view. OBJECTIVE To evaluate the impact of high-definition (HD) 2D vs 3D HD endoscopes on spatial orientation within the sphenoid sinus. METHODS In this prospective single-center study, 21 patients have been investigated (2021-2022). Eleven standardized anatomic landmarks, which were preoperatively defined on neuronavigation imaging, were intraoperatively targeted with a navigation probe using either 2D HD or 3D HD endoscopes for visualization. RESULTS Overall, 3D HD endoscopes provided a statistically significant higher accuracy of identification of sphenoid sinus landmarks (median deviation: 5.2 mm vs 4.2 mm, P < .001). In detail: tuberculum sellae (3.0 mm vs 4.3 mm, P = .047), most anterior point of sella (3.3 mm vs 4.8 mm, P = .049), and clivus indentation (3.8 mm vs 5.3 mm, P = .035). Anatomic variations such as a complex sphenoid sinus configuration had no influence on identifying sphenoid sinus landmarks. CONCLUSION According to our data, stereoscopic 3D HD endoscopy enhances intraoperative orientation by improved depth perception within the sphenoid sinus. This may add to the safety of endoscopic skull base procedures, especially in extended approaches and cases with distorted anatomy.
Collapse
Affiliation(s)
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Simon Heck
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Graz, Styria, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Nassimizadeh A, Lancer H, Hodson J, Ahmed S. Three-Dimensional Endoscopic Endonasal Surgery: A Systematic Review. Laryngoscope 2021; 132:1895-1903. [PMID: 34800043 DOI: 10.1002/lary.29939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To compare participant performance and preference in the use of three-dimensional (3D) endoscopy compared to traditional two-dimensional (2D) endoscopy. METHODS PubMed, Embase, Medline, ClinicalKey, BMJ Case Reports, and the Cochrane library were systematically searched for English-language articles published between 2005 and 2020. Studies reporting comparisons of outcomes between 3D and 2D endoscopes were identified. Data relating to performance-related outcomes, as well as the participants' preferred endoscope were extracted, and pooled using meta-analysis models. RESULTS Ten studies were included in the qualitative synthesis. Six studies reported results of participants completing simulated tasks with endoscopes, while four reported full procedures. Peg transfer tasks (n = 4 cohorts) were found to be completed significantly faster with the 3D versus 2D endoscope (pooled mean difference 6.8 seconds, 95% confidence interval [CI]: 2.3-11.3), while no significant difference in times taken was observed for touch tasks (n = 4; pooled mean difference 3.7 seconds, 95% CI: -1.9 to 9.2). The secondary outcome of participant preference was reported by five studies, in which a significant preference for the 3D endoscope was observed (P = .010), with a pooled total of 72% (95% CI: 59-83) of participants preferring this to the 2D endoscope. CONCLUSIONS There is a growing body of evidence in support of 3D visualization in endoscopy. We have demonstrated 3D endoscopy to be associated with a significantly shorter time to performing simulated, reproducible and controlled tasks, and to be the preference of participants. This study provides grounds for further evaluation of the technology, and the potential for a greater widespread use. Laryngoscope, 2021.
Collapse
Affiliation(s)
- Abdul Nassimizadeh
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Hannah Lancer
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - James Hodson
- Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shahzada Ahmed
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
5
|
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) 2021; 19:281-287. [PMID: 31960059 DOI: 10.1093/ons/opz426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/01/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The differences between 3-dimensional (3D) high definition (HD) and 2-dimensional (2D) 4-K ultra-HD (4K) endoscopy and their respective advantages remain unclear. OBJECTIVE To evaluate the utility of these endoscopy systems in endonasal skull base surgery. METHODS Consecutive series of endoscopic endonasal surgeries performed after introduction of 3D/HD and 2D/4K systems (July 2017) were retrospectively evaluated. Sporadic cases treated with either system, or a conventional 2D standard definition (SD) system, during the rental period from March 2016 were also included. Objective comparisons between the systems were made for newly diagnosed Knosp grade 0 to 3 pituitary adenomas. Surgical procedures were divided into nasal, sphenoidal, and intradural phases, and the surgical procedural time was compared for each phase. The time required for and accuracy of suturing the sellar floor dura was also evaluated. RESULTS A total of 74 cases were treated with 3D/HD and/or 2D/4K, and 12 cases with 2D/SD. 3D/HD was advantageous in the nasal phase because of its intuitive depth perception. 2D/4K was advantageous in the intradural phase because of its superior image quality. Surgical time of the nasal phase with 3D/HD, and that of the intradural phase with 2D/4K, were significantly shorter than that with 2D/SD. The time required for and accuracy of sellar floor dural suturing showed a trend toward improving in the order of 2D/SD, 2D/4K, and 3D/HD. CONCLUSION 3D/HD and 2D/4K endoscopy systems have different advantages, which are useful in distinct surgical phases. Understanding the characteristics of endoscopy systems is important for selecting the most appropriate system for distinct surgical situations.
Collapse
Affiliation(s)
- Yoichi Uozumi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Taniguchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Nakai
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidehito Kimura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toru Umehara
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
6
|
Zhou Y, Eimen RL, Seibel EJ, Bowden AK. Cost-Efficient Video Synthesis and Evaluation for Development of Virtual 3D Endoscopy. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2021; 9:1800711. [PMID: 34950539 PMCID: PMC8673697 DOI: 10.1109/jtehm.2021.3132193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/11/2021] [Accepted: 11/13/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Yaxuan Zhou
- Department of Electrical and Computer EngineeringUniversity of Washington Seattle WA 98195 USA
- Human Photonics LaboratoryDepartment of Mechanical EngineeringUniversity of Washington Seattle WA 98195 USA
| | - Rachel L Eimen
- Department of Biomedical EngineeringVanderbilt University Nashville TN 37232 USA
| | - Eric J Seibel
- Human Photonics LaboratoryDepartment of Mechanical EngineeringUniversity of Washington Seattle WA 98195 USA
| | - Audrey K Bowden
- Department of Biomedical EngineeringVanderbilt University Nashville TN 37232 USA
- Department of Electrical Engineering and Computer ScienceVanderbilt University Nashville TN 37232 USA
| |
Collapse
|
7
|
Capaccio P, Di Pasquale D, Bresciani L, Torretta S, Pignataro L. 3D video-assisted trans-oral removal of deep hilo-parenchymal sub-mandibular stones. ACTA ACUST UNITED AC 2019; 39:367-373. [PMID: 31388194 PMCID: PMC6966778 DOI: 10.14639/0392-100x-2282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
The aim of this paper is to describe the intra-operative findings and surgical results of the first application of 3D high-definition (HD) endoscopic support to the trans-oral surgical treatment of five patients with deep hilo-parenchymal sub-mandibular stones who underwent clinical and ultrasonographic (US) follow-up examinations at one month after the procedure. Five patients undergoing 2D-HD video-assisted transoral surgery for the same condition were used as controls. The results were classified as successful (US - demonstrated complete clearance) or unsuccessful (US - demonstrated total or partial persistence). Visual analogue scales (VAS) were used post-surgically to evaluate the sharpness and brightness of the 2D and 3D images on the screen and stereoscopic depth perception (SDP) of the 3D-HD endoscope. Successful stone removal and significant subjective improvement (lack of obstructive symptoms) was obtained in all but one of the patients in the 3D group, in whom the one-month US evaluation revealed a residual 3 mm asymptomatic hilo-parenchymal stone that was successfully treated by sialendoscopy-assisted intra-corporeal laser lithotripsy. Wharton’s duct and the lingual nerve were identified and preserved in all cases. The mean 3D-HD VAS results were brightness 7 (range 6-8), sharpness 7.8 (range 7-9) and SDP 8.2 (range 8-9); the mean 2D-HD results were brightness 7.8 (range 7-9) and sharpness 7 (range 7-8). Our findings confirm the safety and efficacy of conservative transoral surgical treatment of hilo-parenchymal sub-mandibular stones. From a surgeon’s perspective, 3D-HD guided exploration of the oral floor seems to provide a better view of Wharton’s duct and the lingual nerve, especially near the sub-mandibular parenchyma. The 3D-HD video-assisted transoral removal of deep hilo-parenchymal sub-mandibular stones can therefore be considered a useful new means of preserving the function of an obstructed salivary gland.
Collapse
Affiliation(s)
- P Capaccio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Italy
| | - D Di Pasquale
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - L Bresciani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - S Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - L Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| |
Collapse
|
8
|
Bickerton R, Nassimizadeh AK, Ahmed S. Three-dimensional endoscopy: The future of nasoendoscopic training. Laryngoscope 2019; 129:1280-1285. [PMID: 30628084 DOI: 10.1002/lary.27812] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/03/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Three-dimensional (3D) endoscopy is an emerging tool in surgery that provides real-time depth perception. Its benefits have been investigated in surgical training, but the current literature lacks significant objective outcome data. We aimed to objectively compare the efficacy of two-dimensional (2D) versus 3D high-definition endoscopes in novice users. STUDY DESIGN Prospective, randomized crossover study. METHODS Ninety-two novice medical students who used both 2D and 3D endoscopes to complete two validated tasks in a box trainer participated in the study. Time taken and error rates were measured, and subjective data were collected. RESULTS Wilcoxon tests showed 3D technology was significantly faster than 2D (78 vs. 95 seconds, P = .004), and errors per task were significantly lower (3 vs. 5, P < .001). Sixty-nine percent of participants preferred the 3D endoscope. CONCLUSIONS 3D high-definition endoscopy could be instrumental in training the next generation of endoscopic surgeons. Further research is required in a clinical setting. LEVEL OF EVIDENCE 2b Laryngoscope, 129:1280-1285, 2019.
Collapse
Affiliation(s)
| | - Abdul-Karim Nassimizadeh
- Department of Ear, Nose and Throat (ENT) Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shahzada Ahmed
- Department of Ear, Nose and Throat (ENT) Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
9
|
Nassimizadeh A, Zaidi SM, Nassimizadeh M, Kholief A, Ahmed SK. Endoscopic training-is the future three-dimensional? Laryngoscope Investig Otolaryngol 2018; 3:345-348. [PMID: 30410987 PMCID: PMC6209622 DOI: 10.1002/lio2.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/09/2018] [Accepted: 07/12/2018] [Indexed: 01/26/2023] Open
Abstract
Background/Objectives Endoscopic surgery has a distinct disadvantage compared to direct vision: loss of binocular vision. Three-dimensional endoscopy has been welcomed due to the promise of improving stereopsis. Methods Prospective randomized study of junior doctors with minimal endoscopic experience, using both two-dimensional and three-dimensional, zero-degree, 4-mm Storz endoscopes. Data was collected using validated, standardized training models, both objectively and subjectively. Paired comparisons between variables relating to the endoscopes were performed using Wilcoxon's tests. Operators were then split into groups based on their endoscope preference, with comparisons made using Mann-Whitney tests for Likert scale responses, Kendall's tau for ordinal variables, and Fisher's exact tests for nominal variables. Results Reduction of field of vision of three-dimensional endoscopy by 2%. Significant findings included decreased past-pointing, improved depth and perception and image quality. Conclusion The use of an endoscopic endonasal approach with three-dimensional technology has measurable advantages for novice users, and highlights potential tailoring of future surgical training. Level of Evidence 1b.
Collapse
Affiliation(s)
| | - S M Zaidi
- From the Department of Otorhinolaryngology Birmingham UK
| | | | - Amir Kholief
- From the Department of Otorhinolaryngology Birmingham UK
| | | |
Collapse
|
10
|
Xu J, Liao K, Luo Y. Clinical Study of Three Dimensional Endoscopic Technique in the Treatment of Thyroid Neoplasm. J Laparoendosc Adv Surg Tech A 2018; 28:1003-1007. [PMID: 29698122 DOI: 10.1089/lap.2017.0689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of three-dimensional (3D) endoscopic technique in clinical practice. METHODS A retrospective analysis of the clinical data of 180 cases of endoscopic thyroid surgery, 88 cases by umbrella 3D endoscopic technique (observation group), 92 cases with common endoscopic technique (control group), comparing two groups of patients with age, surgery related indicators, postoperative complications, recovery condition and others. RESULTS There was no significant difference in the average age, tumor diameter, intraoperative bleeding, postoperative drainage, hospitalization time, and pain scores after surgery between the to groups (P > .05); the operation time of the observation group was shorter than the control group [(93.8 + 33.7) minutes versus (135.5 + 37.5) minutes, P < .05]. There was no hoarseness in the observation group, and 2 cases in the control group had transient hoarseness and no permanent hoarseness. CONCLUSION The surgical application of 3D endoscopic technique can shorten the time of endoscopic thyroid surgery, reduce the risk of recurrent laryngeal nerve injury, reduce the operation difficulty and operation pressure, greatly reduce the risk of surgical patients, and increase the safety of surgery.
Collapse
Affiliation(s)
- Jiasheng Xu
- 1 Graduate School of Nanchang University , Nanchang, China .,2 Department of General Surgery, First Affiliated Hospital of Nanchang University , Nanchang, China
| | - Kaili Liao
- 1 Graduate School of Nanchang University , Nanchang, China
| | - Yuting Luo
- 2 Department of General Surgery, First Affiliated Hospital of Nanchang University , Nanchang, China
| |
Collapse
|
11
|
Spille J, Wenners A, von Hehn U, Maass N, Pecks U, Mettler L, Alkatout I. 2D Versus 3D in Laparoscopic Surgery by Beginners and Experts: A Randomized Controlled Trial on a Pelvitrainer in Objectively Graded Surgical Steps. JOURNAL OF SURGICAL EDUCATION 2017; 74:867-877. [PMID: 28215494 DOI: 10.1016/j.jsurg.2017.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 01/30/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Progress in endoscopic surgery in the past few decades has led to the application of 3-dimensional (3D) procedures in operating rooms. This permits patient- and surgeon-friendly operations and also maximizes the superiority of laparoscopy over laparotomy. In this study, we compare 2-dimensional (2D) and 3D endoscopy techniques with regard to time, efficiency, optics, and handling by users with different degrees of experience at 4 difficulty levels. DESIGN A randomized controlled trial on a pelvitrainer in objectively graded surgical steps for students and postgraduates. SETTING The trials took place at the Kiel School of Gynaecological Endoscopy, a training unit of the Kiel University Department of Obstetrics and Gynecology, a tertiary academic medical center. PARTICIPANTS The 277 study participants, divided into students, residents, and specialists, worked on pelvitrainers with 2 different optical systems, the 2D full HD and the 3D mode. The following 4 exercises were performed with each optical system: (1) grasping and transferring of pins, (2) cutting predetermined marks, (3) vaginal closure with prevention of prolapse, and (4) sacrocolpopexy. The duration and success of the tasks were measured and compared. A self-assessment questionnaire was completed by the participants. RESULTS Overall, the 3D-system permitted a greater improvement in working speed, superior optical visualization, and better endoscopic handling in all groups, independent of surgical experience. All students improved in speed (exercises: 1-3) and made significantly fewer mistakes (exercise 2) on 3D compared with 2D. Residents made progress in time (exercises: 1-4) and task performance (exercise 3). Specialists improved significantly in the more challenging tasks 3 and 4. Subjectively, 68.8% of participants preferred 3D for performing laparoscopy. CONCLUSION Systematic training programs on pelvitrainers can improve endoscopic skills not only in beginners but also in experienced surgeons. The 3D system offered distinct advantages over 2D imaging and was well accepted by surgeons.
Collapse
Affiliation(s)
- Johannes Spille
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Antonia Wenners
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany; Department of Reproductive Medicine, Fertility Center Kiel, Park Clinic, Kiel, Germany
| | - Ulrike von Hehn
- Institute of Medical Informatics and Statistics, Medistat, Kiel, Germany
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ulrich Pecks
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Liselotte Mettler
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany.
| |
Collapse
|