Three-Dimensional Versus Two-Dimensional Neuroendoscopy: A Preclinical Laboratory Study

Use of traditional two-dimensional (2-D) neuroendoscopy is limited by lack of depth perception. The advent of next-generation three-dimensional (3-D) endoscopes potentially compensates for this limitation. The aim of this study was to objectively compare the 2 modalities in a controlled laboratory environment.

Using 2-D and 3-D endoscopes, 8 participants performed simple and complex motor tasks. Participants were divided into 3 groups: novice (n = 3), beginner (n = 4), and expert (n = 1), based on prior neuroendoscopy training. Efficiency of completing simple motor tasks in an allocated time and time to complete complex motor tasks were recorded for both visualization methods with demerits for inaccuracy.

Inaccuracy was reduced with increasing experience in the use of the 3-D endoscope for simple motor tasks such as spiral drawing (P = 0.04), but there was no statistical difference in completion time for complex motor tasks pertaining to depth perception among the groups (P > 0.05) or within groups for simple or complex tasks. To assess the impact on the learning curve, we analyzed the performance improvement in use of the other endoscope based on which endoscope each participant used first. There was marked improvement in accuracy and efficiency of 2-D scope use in the "3-D first" group for performing simple motor tasks such as dotted-line drawing (P = 0.002), but no benefit was observed for complex motor tasks.

Our data do not support the superiority of the 3-D endoscope over its conventional 2-D congener, although its use may shorten the learning curve associated with neuroendoscopy, regardless of subjects' prior experience with neuroendoscopy.