title: Three-dimensional high-definition neuroendoscopic surgery: a controlled comparative laboratory study with two-dimensional endoscopy and clinical application.
abstract: BACKGROUND
  The purpose of this research was to investigate the usefulness of three-dimensional (3D) endoscopy compared with two-dimensional (2D) endoscopy in neuroendoscopic surgeries in a comparative study and to test the clinical applications.
  
  
  METHODS
  Forty-three examinees were divided into three groups according to their endoscopic experience: novice, beginner, or expert. Examinees performed three separate tasks using 3D and 2D endoscopy. A recently developed 3D high-definition (HD) neuroendoscope, 4.7 mm in diameter (Shinko Optical Co., Ltd., Tokyo, Japan) was used. In one of the three tasks, we developed a full-sized skull model of acrylic-based plastic using a 3D printer and a patient's thin slice computed tomography data, and evaluated the execution time and total path length of the tip of the pointer using an optical tracking system. Sixteen patients underwent endoscopic transnasal transsphenoidal pituitary surgery using both 3D and 2D endoscopy.
  
  
  RESULTS
  Horizontal motion was evaluated using task 1, and anteroposterior motion was evaluated with task 3. Execution time and total path length in task 3 using the 3D system in both novice and beginner groups were significantly shorter than with the 2D system (p < 0.05), although no significant difference between 2D and 3D systems in task 1 was seen. In both the novice and beginner groups, the 3D system was better for depth perception than horizontal motion. No difference was seen in the expert group in this regard. The 3D HD endoscope was used for the pituitary surgery and was found very useful to identify the spatial relationship of carotid arteries and bony structures.
  
  
  CONCLUSIONS
  The use of a 3D neuroendoscope improved depth perception and task performance. Our results suggest that 3D endoscopes could shorten the learning curve of young neurosurgeons and play an important role in both general surgery and neurosurgery.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Inoue
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimoto
authors.forename: Munenori
authors.initials: M
authors.lastname: Uemura
authors.forename: Masaki
authors.initials: M
authors.lastname: Yoshida
authors.forename: Kenoki
authors.initials: K
authors.lastname: Ohuchida
authors.forename: Hajime
authors.initials: H
authors.lastname: Kenmotsu
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Tomio
authors.initials: T
authors.lastname: Sasaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003867:Depth Perception; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D044583:Neuroendoscopy / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000033:anatomy & histology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery; D012886:Skull / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery; D025321:Surgery, Computer-Assisted; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D055815:Young Adult