A randomized comparison of laparoscopic, flexible endoscopic, and wired and wireless magnetic cameras on ex vivo and in vivo NOTES surgical performance.
BACKGROUND
The influence of endoscopic video camera (VC) image quality on surgical performance has not been studied. Flexible endoscopes are used as substitutes for laparoscopes in natural orifice translumenal endoscopic surgery (NOTES), but their optics are originally designed for intralumenal use. Manipulable wired or wireless independent VCs might offer advantages for NOTES but are still under development.


OBJECTIVE
To measure the optical characteristics of 4 VC systems and to compare their impact on the performance of surgical suturing tasks.


METHODS
VC systems included a laparoscope (Storz 10 mm), a flexible endoscope (Olympus GIF 160), and 2 prototype deployable cameras (magnetic anchoring and guidance system [MAGS] Camera and PillCam). In a randomized fashion, the 4 systems were evaluated regarding standardized optical characteristics and surgical manipulations of previously validated ex vivo (fundamentals of laparoscopic surgery model) and in vivo (live porcine Nissen model) tasks; objective metrics (time and errors/precision) and combined surgeon (n = 2) performance were recorded.


RESULTS
Subtle differences were detected for color tests, and field of view was variable (65°-115°). Suitable resolution was detected up to 10 cm for the laparoscope and MAGS camera but only at closer distances for the endoscope and PillCam. Compared with the laparoscope, surgical suturing performances were modestly lower for the MAGS camera and significantly lower for the endoscope (ex vivo) and PillCam (ex vivo and in vivo).


CONCLUSIONS
This study documented distinct differences in VC systems that may be used for NOTES in terms of both optical characteristics and surgical performance. Additional work is warranted to optimize cameras for NOTES. Deployable systems may be especially well suited for this purpose.
University of Texas Southwestern Medical Center, Dallas, TX 75390-9156, USA. victoria.chang@utsouthwestern.edu
Victoria C
VC
Chang
Shou-Jiang
SJ
Tang
C Paul
CP
Swain
Richard
R
Bergs
Juan
J
Paramo
Deborah C
DC
Hogg
Raul
R
Fernandez
Jeffrey A
JA
Cadeddu
Daniel J
DJ
Scott
D000818:Animals; D019723:Endoscopes; D007091:Image Processing, Computer-Assisted; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods*; D011897:Random Allocation; D013552:Swine; D014741:Video Recording / Q000295:instrumentation*