Ichikawa Yuichi, Tobita Miho, Ito Tomoyuki, Oba Shinichi, Matsumoto Fumihiko, Ramakrishnan Anand, Mizuno Hiroshi
Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
JAMA Otolaryngol Head Neck Surg. 2025 Jul 1;151(7):710-713. doi: 10.1001/jamaoto.2025.1128.
Three-dimensional (3D) monitor-assisted microsurgery, using images from an exoscope or digital microscope, offers ergonomic advantages for surgeons and facilitates educational collaboration. However, challenges remain with the placement of monitors and assistant positioning.
To evaluate the usability of a new head-mounted 3D display, the 3D View Vision, combined with the existing exoscope device, ORBEYE, for improved ergonomic positioning for surgeons and compatible visualization in microsurgical procedures.
DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was conducted involving patients undergoing head and neck reconstruction requiring microvascular anastomosis at a single surgical center. The head-mounted 3D display was used in combination with the exoscope device during the procedures. This researcH was conducted from April 2023 to November 2023.
The surgeon and assistant used the head-mounted 3D display for 3D visualization of the surgical field without the need for both 3D monitor and conventional optical microscope.
The primary outcome was successful completion of microvascular anastomosis with with comparable time, adequate visualization, and subjective ergonomic improvement. Secondary outcomes included intraoperative complications and teamwork efficiency.
The patient mean (SD) age was 59.8 (9.1) years and all were male individuals. Microvascular anastomosis was successfully completed in all 5 patients. The use of the head-mounted 3D display allowed both the surgeon and assistant to position themselves ergonomically, facing each other directly, without concern of the positioning of monitors. End-to-end anastomosis for artery and end-to-side anastomosis for vein was conducted with a mean (SD) time of 23.0 (3.1) and 24.6 (6.9) minutes for each vessel type. Intraoperative reanastomosis was required in 1 patient due to arterial issues, but no other complications were reported.
This study found that the integration of the head-mounted 3D display with the exoscope device subjectively improved ergonomics for the surgeon and better visualization compared with using a 3D monitor and exoscope. By eliminating the need for monitor positioning, this technology also declutters the theater workspace.
使用外视镜或数字显微镜图像的三维（3D）显示器辅助显微手术，对外科医生而言具有人体工程学优势，并便于开展教育合作。然而，显示器的放置和助手的定位仍存在挑战。
评估一种新型头戴式3D显示器（3D View Vision）与现有外视镜设备ORBEYE相结合的可用性，以改善外科医生的人体工程学定位，并在显微手术过程中实现兼容的可视化。
设计、地点和参与者：在一个单一手术中心对需要进行微血管吻合的头颈重建患者开展了一项前瞻性观察研究。手术过程中使用了头戴式3D显示器与外视镜设备相结合的方式。本研究于2023年4月至2023年11月进行。
外科医生和助手使用头戴式3D显示器对手术视野进行3D可视化，无需使用3D显示器和传统光学显微镜。
主要结局是在可比的时间内成功完成微血管吻合，具备足够的可视化效果，且主观上人体工程学得到改善。次要结局包括术中并发症和团队协作效率。
患者的平均（标准差）年龄为59.8（9.1）岁，均为男性。所有5例患者均成功完成微血管吻合。使用头戴式3D显示器使外科医生和助手都能以符合人体工程学的方式定位，直接面对面，而无需担心显示器的位置。动脉端端吻合和静脉端侧吻合的平均（标准差）时间分别为每种血管类型23.0（3.1）分钟和24.6（6.9）分钟。1例患者因动脉问题需要术中再次吻合，但未报告其他并发症。
本研究发现，与使用3D显示器和外视镜相比，头戴式3D显示器与外视镜设备的整合在主观上改善了外科医生的人体工程学，并实现了更好的可视化。通过消除对显示器定位的需求，该技术还使手术区域的工作空间更加整洁。
