Dhingra Juslyn, Beinart Noah, Ahmed Abraar, Patel Mansi, Ameerah Aysha, Srinivasan Maansi, Idelson Christopher R, Uecker John M
The College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA. (Ms. Dhingra, Ms. Patel, Mr. Ahmed, and Ms. Ameerah).
The McCombs School of Business, The University of Texas at Austin, Austin, TX, USA. (Mr. Beinart).
JSLS. 2025 Jul-Sep;29(3). doi: 10.4293/JSLS.2025.00023. Epub 2025 Jul 14.
Minimally invasive surgery (MIS) offers faster recovery and smaller incisions but is limited by persistent visualization issues such as lens fogging, debris, and camera instability. These challenges compromise surgical performance, increase complications, and elevate healthcare costs. This review evaluates the clinical and economic impact of suboptimal visualization in MIS and explores potential solutions.
A systematic review was conducted using peer-reviewed literature from January 1990 to August 2024. Studies included those examining visualization challenges in laparoscopic and robotic MIS, clinical outcomes, surgeon-reported frustrations, and cost analyses. Exclusion criteria included studies with significant conflicts of interest, especially those funded by medical device companies.
Surgeons spend an estimated 40% of MIS operating time under suboptimal visual conditions, contributing to nearly 20% of surgical complications. Lens cleaning adds $132-$493 per procedure, averaging $312.53 based on 9.7 cleaning events per case. Visualization-related complications contribute an additional $251 per case. Combined, these issues result in over $2.2 billion in annual costs in the U.S. Poor visualization also disrupts workflow, increases surgeon fatigue, and hinders integration of emerging technologies such as artificial intelligence (AI).
Suboptimal visualization in MIS stands to significantly affect patient safety and healthcare costs. Addressing these challenges through standardized cleaning protocols, improved surgeon training, and adoption of advanced technologies-including AI-driven imaging-is essential. Enhancing visualization is not just a technical upgrade but a critical step toward safer, more efficient, and cost-effective surgical care.
微创手术（MIS）具有恢复快、切口小的优点，但受持续存在的可视化问题限制，如镜头起雾、碎片和摄像头不稳定。这些挑战会影响手术操作，增加并发症，并提高医疗成本。本综述评估了微创手术中可视化不佳的临床和经济影响，并探索潜在解决方案。
使用1990年1月至2024年8月的同行评审文献进行系统综述。研究包括那些检查腹腔镜和机器人微创手术中的可视化挑战、临床结果、外科医生报告的挫折感以及成本分析的研究。排除标准包括存在重大利益冲突的研究，特别是那些由医疗器械公司资助的研究。
据估计，外科医生在可视化条件不佳的情况下花费约40%的微创手术操作时间，导致近20%的手术并发症。每次手术的镜头清洁费用为132美元至493美元，基于每例9.7次清洁事件，平均为312.53美元。与可视化相关的并发症每例额外增加251美元。综合起来，这些问题在美国每年造成超过22亿美元的成本。可视化不佳还会扰乱工作流程，增加外科医生的疲劳，并阻碍人工智能（AI）等新兴技术的整合。
微创手术中可视化不佳可能会显著影响患者安全和医疗成本。通过标准化清洁方案、改进外科医生培训以及采用包括人工智能驱动成像在内的先进技术来应对这些挑战至关重要。改善可视化不仅是技术升级，也是迈向更安全、高效和具有成本效益的手术护理的关键一步。
