Three-dimensional neurostereoendoscopy: subjective and objective comparison to 2D

Neuroendoscopic procedures, particularly transnasal skull-base procedures, are currently performed with 2D endoscopes that lack stereoscopic vision and depth of field. In principal, 3D vision should be preferable to the operating surgeon, but the previously existing systems have not been adopted. We evaluated a novel 3D endoscope to compare with 2D endoscopy. 33 neurosurgeons and skull-base otolaryngologists were recruited, and randomized to complete two runs of a task-based simulator paradigm using 2D and/or 3D visualization. After the two trials, each subject completed a questionnaire assessing professional demographics and preferences for visualization. The task paradigm had objective endpoints that measured speed, efficiency, and error rates. 75% of respondents preferred 3D endoscopy, and 87.5% determined that 3D visualization either somewhat or greatly helped with the assigned tasks. In the second run, subjects using 3D demonstrated a significantly higher efficiency than subjects using 2D (p=0.04). Subjects' speed and efficiency improved significantly when moving from 2D to 3D, and speed and efficiency improved significantly from Run 1 to Run 2 for 3D visualization. Subjective and objective outcomes support the utility of 3D visualization for neuroendoscopic techniques. Visualization that provides real-time, high-resolution binocular depth perception has a role in endoscopic skull base surgery and other neuroendoscopic procedures.