title: Three-dimensional virtual navigation versus conventional image guidance: A randomized controlled trial.
abstract: Providing image guidance in a 3-dimensional (3D) format, visually more in keeping with the operative field, could potentially reduce workload and lead to faster and more accurate navigation. We wished to assess a 3D virtual-view surgical navigation prototype in comparison to a traditional 2D system.
  
  
  
  Thirty-seven otolaryngology surgeons and trainees completed a randomized crossover navigation exercise on a cadaver model. Each subject identified three sinonasal landmarks with 3D virtual (3DV) image guidance and three landmarks with conventional cross-sectional computed tomography (CT) image guidance. Subjects were randomized with regard to which side and display type was tested initially. Accuracy, task completion time, and task workload were recorded.
  
  
  
  Display type did not influence accuracy (P > 0.2) or efficiency (P > 0.3) for any of the six landmarks investigated. Pooled landmark data revealed a trend of improved accuracy in the 3DV group by 0.44 millimeters (95% confidence interval [0.00-0.88]). High-volume surgeons were significantly faster (P < 0.01) and had reduced workload scores in all domains (P < 0.01), but they were no more accurate (P > 0.28).
  
  
  
  Real-time 3D image guidance did not influence accuracy, efficiency, or task workload when compared to conventional triplanar image guidance. The subtle pooled accuracy advantage for the 3DV view is unlikely to be of clinical significance. Experience level was strongly correlated to task completion time and workload but did not influence accuracy.
  
  
  
  N/A. Laryngoscope, 126:1510-1515, 2016.
authors.affiliation: Department of Surgery, University of Melbourne, St Vincent's Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Dixon
authors.affiliation: Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Harley
authors.initials: H
authors.lastname: Chan
authors.affiliation: Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.|Institute of Medical Science, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Daly
authors.affiliation: Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Vescan
authors.affiliation: Departments of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.|Otolaryngology-Head and Neck Surgery, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.|Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Witterick
authors.affiliation: Departments of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.|Otolaryngology-Head and Neck Surgery, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D002102:Cadaver; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging* / Q000601:surgery; D066231:Surgeons / Q000706:statistics & numerical data; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013647:Task Performance and Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016526:Workload
keywords: Virtual reality; endoscopic surgery; image-guided surgery; paranasal sinuses; surgical navigation