Investigation of Surgical Precision and Efficiency in A Laboratory Model of Endoscopic Endonasal Dural Suturing: Is 3D Endoscopy Superior to 2D Endoscopy?

Background: Endonasal suturing (ES) for primary dural repair has been reported by some authors to dramatically reduce the incidence of CSF fistulas following expanded endonasal approaches. However, this technique is infrequently utilized in contemporary neurosurgical practice because of a steep technical learning curve felt to relate to instrument- and corridor-specific variables, as well as limitations, in depth perception associated with 2D endoscopy. Improvements in depth perception provided by newer generation 3D endoscopes may facilitate enhanced surgical dexterity in the endonasal corridor; however, this remains poorly investigated.

Methods: A previously validated laboratory model meant to simulate ES was constructed by pairing a 3D-printed endonasal corridor and cranial base with tissue allograft meant to simulate the dural layer. Twenty-six total participants were divided into groups according to their endoscopic experience: novice (14), intermediate (8), and expert (4). Participants were asked to place two sutures to repair a laceration in the simulated dural layer using both 2D and 3D endoscopic visualization. Surgical precision and efficiency were assessed.

Results: In the group of 26 participants, there was no statistical difference in surgical precision (p = 0.33) or efficiency (p = 0.67) based on use of 2D versus 3D endoscopy. Following subgroup analysis, expert surgeons were noted to be more precise and efficient than novice (2D, p = 0.51; 3D, p = 0.06) or intermediate surgeons (2D, p = 0.95; 3D, p = 0.42); however, this did not reach statistical significance.

Conclusion: Improved-depth perception offered by the 3D endoscope did not translate to improved surgical performance in a simulated model of endoscopic ES.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021