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J Neurol Surg B Skull Base 2022; 83(04): 423-429
DOI: 10.1055/s-0041-1736635
Original Article

2D versus 3D Endoscopy: Head-to-Head Comparison in a Simulated Model of Endoscopic Endonasal Dural Suturing

Ivanna Nebor
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Zoe Anderson
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Juan C. Mejia-Munne
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Ahmed Hussein
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Kora Montemagno
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Rebecca Fumagalli
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Ikrame Labiad
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Yash Patil
2   Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Norberto Andaluz
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Ahmad R. Sedaghat
2   Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Mario Zuccarello
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Jonathan A. Forbes
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Abstract

Objective Endonasal dural suturing (EDS) has been reported to decrease the incidence of cerebrospinal fluid fistula. This technique requires handling of single-shaft instrumentation in the narrow endonasal corridor. It has been proposed that three-dimensional (3D) endoscopes were associated with improved depth perception. In this study, we sought to perform a comparison of two-dimensional (2D) versus 3D endoscopy by assessing surgical proficiency in a simulated model of EDS.

Materials and Methods Twenty-six participants subdivided into groups based on previous endoscopic experience were asked to pass barbed sutures through preset targets with either 2D (Storz Hopkins II) or 3D (Storz TIPCAM) endoscopes on 3D-printed simulation model. Surgical precision and procedural time were measured. All participants completed a Likert scale questionnaire.

Results Novice, intermediate, and expert groups took 11.0, 8.7, and 5.7 minutes with 2D endoscopy and 10.9, 9.0, and 7.6 minutes with 3D endoscopy, respectively. The average deviation for novice, intermediate, and expert groups (mm) was 5.5, 4.4, and 4.3 with 2D and 6.6, 4.6, and 3.0 with 3D, respectively. No significant difference in procedural time or accuracy was found in 2D versus 3D endoscopy. 2D endoscopic visualization was preferred by the majority of expert/intermediate participants, while 3D endoscopic visualization by the novice group.

Conclusion In this pilot study, there was no statistical difference in procedural time or accuracy when utilizing 2D versus 3D endoscopes. While it is possible that widespread familiarity with 2D endoscopic equipment has biased this study, preliminary analysis suggests that 3D endoscopy offers no definitive advantage over 2D endoscopy in this simulated model of EDS.

Keywords

2D endoscope - 3D endoscope - dural suturing - 3D model - surgical simulator

Note

The abstract of the study was accepted as poster at the 31th North American Skull Base Society Annual Meeting (February 2021) and as an e-poster presentation at the AANS Annual Scientific Meeting (August, 2021, Orlando, Florida, United States).




Publication History

Received: 23 July 2021

Accepted: 21 September 2021

Article published online:
08 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Oostra A, van Furth W, Georgalas C. Extended endoscopic endonasal skull base surgery: from the sella to the anterior and posterior cranial fossa. ANZ J Surg 2012; 82 (03) 122-130
    CrossrefPubMedGoogle Scholar
  • 2 Thomas R, Chacko AG. Principles in skull base reconstruction following expanded endoscopic approaches. J Neurol Surg B Skull Base 2016; 77 (04) 358-363
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Pereira EAC, Grandidge CA, Nowak VA, Cudlip SA. Cerebrospinal fluid leaks after transsphenoidal surgery - effect of a polyethylene glycol hydrogel dural sealant. J Clin Neurosci 2017; 44: 6-10
    CrossrefPubMedGoogle Scholar
  • 4 Radovanovic I, Dehdashti AR, Turel MK. et al. Expanded endonasal endoscopic surgery in suprasellar craniopharyngiomas: a retrospective analysis of 43 surgeries including recurrent cases. Oper Neurosurg (Hagerstown) 2019; 17 (02) 132-142
    CrossrefPubMedGoogle Scholar
  • 5 Kim EH, Roh TH, Park HH, Moon JH, Hong JB, Kim SH. Direct suture technique of normal gland edge on the incised dura margin to repair the intraoperative cerebrospinal fluid leakage from the arachnoid recess during transsphenoidal pituitary tumor surgery. Neurosurgery 2015; 11 (Suppl. 02) 26-31 , discussion 31
    PubMedGoogle Scholar
  • 6 Kizmazoglu C, Ozyoruk S, Husemoglu RB, Kalemci O, Sozer G, Sade B. Comparison of dural closure alternatives: an experimental study. Br J Neurosurg 2019; 33 (06) 655-658
    CrossrefPubMedGoogle Scholar
  • 7 Yamada S, Fukuhara N, Oyama K. et al. Surgical outcome in 90 patients with craniopharyngioma: an evaluation of transsphenoidal surgery. World Neurosurg 2010; 74 (2-3): 320-330
    CrossrefPubMedGoogle Scholar
  • 8 Horiguchi K, Nishioka H, Fukuhara N, Yamaguchi-Okada M, Yamada S. A new multilayer reconstruction using nasal septal flap combined with fascia graft dural suturing for high-flow cerebrospinal fluid leak after endoscopic endonasal surgery. Neurosurg Rev 2016; 39 (03) 419-427
    CrossrefPubMedGoogle Scholar
  • 9 Ahn JY, Kim SH. A new technique for dural suturing with fascia graft for cerebrospinal fluid leakage in transsphenoidal surgery. Neurosurgery 2009;65(6, Suppl):65–71, discussion 71–72
    PubMedGoogle Scholar
  • 10 Felisati G, Pipolo C, Maccari A, Cardia A, Revay M, Lasio GB. Transnasal 3D endoscopic skull base surgery: questionnaire-based analysis of the learning curve in 52 procedures. Eur Arch Otorhinolaryngol 2013; 270 (08) 2249-2253
    CrossrefPubMedGoogle Scholar
  • 11 Ogino-Nishimura E, Nakagawa T, Sakamoto T, Ito J. Efficacy of three-dimensional endoscopy in endonasal surgery. Auris Nasus Larynx 2015; 42 (03) 203-207
    CrossrefPubMedGoogle Scholar
  • 12 Pennacchietti V, Garzaro M, Grottoli S. et al. Three-dimensional endoscopic endonasal approach and outcomes in sellar lesions: a single-center experience of 104 cases. World Neurosurg 2016; 89: 121-125
    CrossrefPubMedGoogle Scholar
  • 13 Roth J, Singh A, Nyquist G. et al. Three-dimensional and 2-dimensional endoscopic exposure of midline cranial base targets using expanded endonasal and transcranial approaches. Neurosurgery 2009; 65 (06) 1116-1128 , discussion 1128–1130
    CrossrefPubMedGoogle Scholar
  • 14 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) 2020; 19 (03) 281-287
    CrossrefPubMedGoogle Scholar
  • 15 Uvelius E, Siesjö P. 3-D endoscopy in surgery of pituitary adenomas, prospective evaluation of patient gain using basic outcome parameters. J Clin Neurosci 2020; 76: 166-170
    CrossrefPubMedGoogle Scholar
  • 16 Barkhoudarian G, Del Carmen Becerra Romero A, Laws ER. Evaluation of the 3-dimensional endoscope in transsphenoidal surgery. Neurosurgery 2013;73(1, Suppl Operative):ons74–ons78, discussion ons78–ons79
    PubMedGoogle Scholar
  • 17 Ergina PL, Cook JA, Blazeby JM. et al; Balliol Collaboration. Challenges in evaluating surgical innovation. Lancet 2009; 374 (9695): 1097-1104
    CrossrefPubMedGoogle Scholar
  • 18 Gulbins H, Boehm DH, Reichenspurner H, Arnold M, Ellgass R, Reichart B. 3D-visualization improves the dry-lab coronary anastomoses using the Zeus robotic system. Heart Surg Forum 1999; 2 (04) 318-324 , discussion 324–325
    PubMedGoogle Scholar
  • 19 Becker H, Melzer A, Schurr MO, Buess G. 3-D video techniques in endoscopic surgery. Endosc Surg Allied Technol 1993; 1 (01) 40-46
    PubMedGoogle Scholar
  • 20 Bickerton R, Nassimizadeh AK, Ahmed S. Three-dimensional endoscopy: the future of nasoendoscopic training. Laryngoscope 2019; 129 (06) 1280-1285
    CrossrefPubMedGoogle Scholar
  • 21 Brown SM, Tabaee A, Singh A, Schwartz TH, Anand VK. Three-dimensional endoscopic sinus surgery: feasibility and technical aspects. Otolaryngol Head Neck Surg 2008; 138 (03) 400-402
    CrossrefPubMedGoogle Scholar
  • 22 Kaufman Y, Sharon A, Klein O. et al. The three-dimensional “insect eye” laparoscopic imaging system-a prospective randomized study. Gynecol Surg 2007; 4 (01) 31-34
    CrossrefPubMedGoogle Scholar
  • 23 Nassimizadeh A, Zaidi SM, Nassimizadeh M, Kholief A, Ahmed SK. Endoscopic training-is the future three-dimensional?. Laryngoscope Investig Otolaryngol 2018; 3 (05) 345-348
    CrossrefPubMedGoogle Scholar
  • 24 Seong SY, Park SC, Chung HJ. et al. Clinical comparison of 3D endoscopic sinonasal surgery between ‘insect eye’ 3D and ‘twin lens’ 3D endoscopes. J Rhinol 2016; 23 (02) 102
    CrossrefPubMedGoogle Scholar
  • 25 Nebor I, Hossein A, Montemagno K. et al. Primary dural suturing via an endoscopic endonasal corridor: preliminary development of a 3D printed model for training. J Neurol Surg B Skull Base 2021; 3: 273-382
    PubMedGoogle Scholar
  • 26 Lindquist NR, Leach M, Simpson MC, Antisdel JL. Evaluating simulator-based teaching methods for endoscopic sinus surgery. Ear Nose Throat J 2019; 98 (08) 490-495
    CrossrefPubMedGoogle Scholar
  • 27 Ishii M, Gallia GL. Application of technology for minimally invasive neurosurgery. Neurosurg Clin N Am 2010; 21 (04) 585-594 , v
    CrossrefPubMedGoogle Scholar