Use of Three-Dimensional Endoscopy in Endonasal and Anterior Skull Base Surgery

Background: Three-dimensional (3D) endoscopy is a new procedure in endonasal and anterior skull base surgery which improve the depth of perception and intraoperative orientation over two-dimensional (2D) endoscopy. Its importance has been demonstrated in surgical training, clinical applications and experimental studies. This study aimed to clarify the difference between uses 2D and 3D endoscopes by novice users and importance of 3D endoscope in cadaveric dissections and surgical techniques in endonasal and anterior skull base surgery.

Methods: This study classified in to three phases (experimental, cadaveric, and clinical phases). First is experimental randomized crossover study of 120 novice medical students recruited from University Of Birmingham, who used both 2D and 3D endoscopes to complete two validated tasks in a box trainer. Time taken and error rates were measured, and subjective data collected. Second phase is cadaveric dissection study which was done on three cadavers by using 2D endoscopy in one side and 3D endoscopy in the other side for each cadaver to detect difference in time and accuracy in dissection of both sides. Third phase “clinical study” was performed on 30 anterior skull base cases (15 control cases using 2D endoscope and 15 study cases using 3D endoscope). Duration of surgery, accuracy and intraoperative complications were recorded.

Results: Wilcoxon’s tests showed attempts using 3D technology were significantly faster than 2D, and errors per task significantly lower.in cadaveric part of the study showed by using 3D endoscope faster dissection and better orientation and depth of perception of anatomical structures in cadavers than using 2D endoscope.in third part (clinical study) showed 3D endoscopic anterior skull base surgery is significantly faster, more accurate and less intraoperative complications than 2D endoscopic usage.

Conclusion: 3D endoscopy will likely be instrumental in training the next generation of ENT surgeons. Clinical and cadaveric studies evaluating the 3D endoscopy show better clinical outcome than 2D endoscopy in patients who require Endoscopic Endonasal Anterior Skull Base Surgery.