PMID- 33386021
OWN - NLM
STAT- MEDLINE
DCOM- 20210929
LR  - 20210929
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 50
IP  - 1
DP  - 2021 Jan
TI  - Impact of different visualization devices on accuracy, efficiency, and dexterity 
      in neurosurgery: a laboratory investigation.
PG  - E18
LID - 2020.10.FOCUS20786 [pii]
LID - 10.3171/2020.10.FOCUS20786 [doi]
AB  - OBJECTIVE: Extracorporeal telescopes (exoscopes) have been the latest addition to 
      the neurosurgeons' armamentarium, acting as a bridge between operating 
      microscopes and endoscopes. However, to the authors' knowledge there are no 
      published preclinical laboratory studies of the accuracy, efficiency, and 
      dexterity of neurosurgical training for the use of 2D or 3D exoscopes compared 
      with microscopes. METHODS: In a controlled experimental setup, 22 participating 
      neurosurgery residents performed simple (2D) and complex (3D) motor tasks with 
      three visualization tools in alternating sequence: a 2D exoscope, 3D exoscope, 
      and microscope, using a block randomization model based on the neurosurgeons' 
      prior training experience (novice, intermediate, and senior: n = 6, 12, and 4, 
      respectively). Performance scores (PS; including error and efficiency scores) and 
      dexterity scores (DS) were calculated to objectify the accuracy, efficiency, and 
      finesse of task performance. Repeated measures ANOVA analysis was used to compare 
      the PS, DS, and cumulative scores (CS) of candidates using the three 
      visualization aids. Bland-Altman plots and intraclass correlation coefficients 
      were generated to quantify intraobserver and interobserver agreement for DS. 
      Subgroup analysis was performed to assess the impact of participants' prior 
      training. A postexercise survey was conducted to assess the comfort level (on a 
      10-point analog scale) of the participants while using each visualization tool 
      for performing the suturing task. RESULTS: PS, DS, and CS were significantly 
      impacted by the visualization tool utilized for 2D motor tasks (p < 0.001 for 
      each), with the microscope faring better than the 2D exoscope (p = 0.04) or 3D 
      exoscope (p = 0.008). The PS for the 3D object transfer task was significantly 
      influenced by the visualization aid used (p = 0.007), with the microscope and 3D 
      exoscope faring better than the 2D exoscope (p = 0.04 for both). The 
      visualization instrument used significantly affected the DS and CS for the 
      suturing task (p < 0.001 for both), with the microscope again scoring better than 
      the 2D exoscope (p < 0.001) or 3D exoscope (p = 0.005). The impact of the 
      visualization aid was more apparent in participants with a shorter duration of 
      residency (novice, p = 0.03; intermediate, p = 0.0004). Participants also felt 
      the greatest operational comfort while working with a microscope, 3D exoscope, 
      and 2D exoscope, in that order (p < 0.0001). CONCLUSIONS: Compared with 3D and 2D 
      exoscopes, an operating microscope provides better dexterity and performance and 
      a greater operational comfort level for neurosurgeons while they are performing 
      2D or 3D motor tasks. For performing complex 3D motor tasks, 3D exoscopes offer 
      selective advantages in dexterity, performance, and operational comfort level 
      over 2D exoscopes. The relative impact of visualization aids on surgical 
      proficiency gradually weakens as the participants' residency duration increases.
FAU - Raheja, Amol
AU  - Raheja A
FAU - Mishra, Shashwat
AU  - Mishra S
FAU - Garg, Kanwaljeet
AU  - Garg K
FAU - Katiyar, Varidh
AU  - Katiyar V
FAU - Sharma, Ravi
AU  - Sharma R
FAU - Tandon, Vivek
AU  - Tandon V
FAU - Goda, Revanth
AU  - Goda R
FAU - Suri, Ashish
AU  - Suri A
FAU - Kale, Shashank S
AU  - Kale SS
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Humans
MH  - Imaging, Three-Dimensional
MH  - Laboratories
MH  - Microsurgery
MH  - *Neurosurgery
MH  - Neurosurgical Procedures
OTO - NOTNLM
OT  - 2D exoscope
OT  - 3D exoscope
OT  - dexterity
OT  - experimental design
OT  - microscope
OT  - neurosurgery
OT  - visualization tools
EDAT- 2021/01/02 06:00
MHDA- 2021/09/30 06:00
CRDT- 2021/01/01 20:16
PHST- 2020/08/31 00:00 [received]
PHST- 2020/10/19 00:00 [accepted]
PHST- 2021/01/01 20:16 [entrez]
PHST- 2021/01/02 06:00 [pubmed]
PHST- 2021/09/30 06:00 [medline]
AID - 2020.10.FOCUS20786 [pii]
AID - 10.3171/2020.10.FOCUS20786 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2021 Jan;50(1):E18. doi: 10.3171/2020.10.FOCUS20786.