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Comparison of two- and three-dimensional endoscopic visualization for fetal myelomeningocele repair: a pilot study using a fetoscopic surgical simulator
Child's Nervous System ( IF 1.4 ) Pub Date : 2021-01-04 , DOI: 10.1007/s00381-020-04999-4
Smruti K Patel 1, 2 , Oleksandra Kashyrina 3 , Soner Duru 4 , Marcos Miyabe 4 , Foong-Yen Lim 4, 5, 6 , Jose L Peiro 4, 5, 6 , Charles B Stevenson 1, 2, 6
Affiliation  

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.



中文翻译:

胎儿脊髓脊膜膨出修复的二维和三维内窥镜可视化的比较:使用胎儿镜手术模拟器的初步研究

介绍

本研究的目的是评估三维 (3D) 与传统二维 (2D) 内窥镜检查在使用低保真胎儿镜手术模拟器修复胎儿脊髓脊膜膨出中的效用。

方法

开发了一种低保真胎儿镜箱训练器,用于脊髓脊膜膨出修复的手术模拟。招募具有不同手术经验的参与者并使用 2D 和 3D 内窥镜可视化完成三项基本任务(切割皮肤、硬脑膜贴片放置和缝合皮肤)。参与者被随机分配以开始 2D 或 3D 的所有任务。对每项任务的完成时间进行了测量,每个参与者随后完成了 NASA 负载指数测试和评估他们体验的问卷。

结果

16 名参与者在模拟器中使用 2D 和 3D 内窥镜完成了研究任务。虽然 3D 与 2D 内窥镜检查的所有任务的平均执行时间较短(切割皮肤,47 对 54 秒;硬脑膜贴片放置,38 对 52 秒;缝合皮肤,424 对 499 秒),但结果并未达到统计显着性。在比较专业水平之间完成三项任务中每一项的时间时,专家类别的参与者在 2D 模式上缝合皮肤时更快(P = 0.047)。在 3D 可视化下,专家切割皮肤的速度更快(P = 0.008)。在比较使用 NASA-TLX 测试的体验时,参与者认为使用 3D 比使用 2D 系统的表现更好(P= 0.045)。总体而言,16 位参与者中有 13 位 (81.3%) 更喜欢 3D 而非 2D 可视化。

结论

在不久的将来,三维内窥镜可能会用于在复杂的胎儿镜检查程序(如脊髓脊膜膨出缺陷的产前修复)中相对改善可视化和可能的性能。将 3D 范围用于其他相关程序的进一步研究可能会支持该技术在胎儿手术中的临床实施,并且也被证明是手术培训中的有用工具。

更新日期:2021-01-04
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