Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2016, Cincinnati, OH, 45229-3039, USA.
Childs Nerv Syst. 2021 May;37(5):1613-1621. doi: 10.1007/s00381-020-04999-4. Epub 2021 Jan 4.
The objective of this study was to evaluate the utility of three-dimensional (3D) versus conventional two-dimensional (2D) endoscopy for fetal myelomeningocele repair using a low-fidelity fetoscopic surgical simulator.
A low-fidelity fetoscopic box trainer was developed for surgical simulation of myelomeningocele repair. Participants with varying surgical experience were recruited and completed three essential tasks (cutting skin, dural patch placement, and suturing skin) using both 2D and 3D endoscopic visualization. Participants were randomized to begin all tasks in either 2D or 3D. Time to completion was measured for each task, and each participant subsequently completed the NASA Load Index test and a questionnaire evaluating their experience.
Sixteen participants completed the study tasks using both 2D and 3D endoscopes in the simulator. While the mean performance time across all tasks was shorter with 3D versus 2D endoscopy (cutting skin, 47 vs. 54 seconds; dural patch placement, 38 vs. 52 seconds; and suturing skin, 424 vs. 499 seconds), the results did not reach statistical significance. When comparing times to completion of each of the three tasks between levels of expertise, participants in the expert category were faster when suturing skin on the 2D modality (P = 0.047). Under 3D visualization, experts were faster at cutting the skin (P = 0.008). When comparing experiences using the NASA-TLX test, participants felt that their performance was better using 3D over the 2D system (P = 0.045). Overall, 13 of 16 (81.3%) participants preferred 3D over 2D visualization.
Three-dimensional endoscopes could potentially be used in the near future for relative improvement in visualization and possibly performance during complex fetoscopic procedures such as prenatal repair of myelomeningocele defects. Further studies utilizing 3D scopes for other related procedures may potentially support clinical implementation of this technology in fetal surgery and also prove to be a useful tool in surgical training.
本研究旨在评估使用低保真胎儿内窥镜手术模拟器对胎儿脊髓脊膜膨出修复时，三维（3D）与传统二维（2D）内镜的应用效果。
开发了一种低保真胎儿内窥镜箱式训练器，用于模拟脊髓脊膜膨出修复手术。招募了具有不同手术经验的参与者，并使用 2D 和 3D 内窥镜可视化技术完成了三项基本任务（切割皮肤、放置硬脑膜补片和缝合皮肤）。参与者随机开始所有任务 2D 或 3D 视图。测量每项任务的完成时间，然后每位参与者完成 NASA 负荷指数测试和评估其体验的问卷。
16 名参与者使用模拟器中的 2D 和 3D 内窥镜完成了所有研究任务。虽然 3D 与 2D 内窥镜相比，所有任务的平均完成时间更短（切割皮肤，47 秒对 54 秒；放置硬脑膜补片，38 秒对 52 秒；缝合皮肤，424 秒对 499 秒），但结果未达到统计学意义。当比较专家和非专家在三个任务中完成时间时，专家在 2D 模式下缝合皮肤时更快（P = 0.047）。在 3D 可视化下，专家在切割皮肤时更快（P = 0.008）。通过 NASA-TLX 测试比较经验时，参与者认为使用 3D 比 2D 系统更好（P = 0.045）。总体而言，16 名参与者中有 13 名（81.3%）更喜欢 3D 而不是 2D 可视化。
在不久的将来，3D 内窥镜可能会用于改善胎儿内窥镜手术中复杂手术（如产前脊髓脊膜膨出修复）的可视化效果，并可能提高手术操作。进一步研究使用 3D 内窥镜进行其他相关手术可能会支持该技术在胎儿手术中的临床应用，并成为手术培训的有用工具。
