Abstract
In the past decade, surgical treatment of skull base pathologies has greatly advanced through the advent of the endoscope and later of the high definition endoscope. Recently a new type of three dimensional (3D) scope has been introduced to permit the surgeon a real stereoscopic vision of the operating field and to overcome the limitations of the 2D endoscopic set up. As with all new technologies a formalized adaptation period is essential for the surgeon to secure steady outcomes and low complications. To determine the subjective difficulties that one may encounter during this sensitive period we therefore devised and analyzed a questionnaire that evaluated the first ten procedures with the 3D device of junior and senior ENT and neurosurgeons. 52 consecutive patients were treated with purely 3D transnasal endoscopy for skull base pathologies. Sensation of strain or dizziness, difficulties in anatomical orientation and difficulties in performing the surgical gesture were assessed for each surgeon. The learning curve and difficulties of junior and senior surgeons are discussed and strategies to overcome the initial problems are devised. Our results confirm that after only few procedures, the advantages of the 3D endoscopic system including better visualization and depth perception are able to outweigh the inconveniences that go hand in hand with the learning of a new skill set.
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References
Nicolai P, Battaglia P, Bignami M, Bolzoni Villaret A, Delù G, Khrais T, Lombardi D, Castelnuovo P (2008) Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10 year experience. Am J Rhinol 22(3):308–316
Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 116(10):1882–1886
Tabaee A, Anand VK, Fraser JF, Brown SM, Singh A, Schwartz TH (2009) Three-dimensional endoscopic pituitary surgery. Neurosurgery 64(5 Suppl 2):288–293 discussion 294–295
Manes RP, Barnett S, Batra PS (2011) Utility of novel 3-dimensional stereoscopic vision system for endoscopic sinonasal and skull-base surgery. Int Forum Allergy Rhinol 1(3):191–197. doi:10.1002/alr.20012
Kari E, Oyesiku NM, Dadashev V, Wise SK (2012) Comparison of traditional 2-dimensional endoscopic pituitary surgery with new 3-dimensional endoscopic technology: intraoperative and early postoperative factors. Int Forum Allergy Rhinol 2(1):2–8. doi:10.1002/alr.20036
Shah RN, Leight WD, Patel MR, Surowitz JB, Wong YT, Wheless SA, Germanwala AV, Zanation AM (2011) A controlled laboratory and clinical evaluation of a three-dimensional endoscope for endonasal sinus and skull base surgery. Am J Rhinol Allergy 25(3):141–144
Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM (2007) Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 117(4):699–705
Roth J, Singh A, Nyquist G, Fraser JF, Bernardo A, Anand VK, Schwartz TH (2009) Three-dimensional and 2-dimensional endoscopic exposure of midline cranial base targets using expanded endonasal and transcranial approaches. JNeurosurgery 65(6):1116–1128 discussion 1128–1130
Wasserzug O, Margalit N, Weizman N, Fliss DM, Gil Z (2010) Utility of a three-dimensional endoscopic system in skull base surgery. Skull Base 20(4):223–228
O’Malley BW Jr, Grady MS, Gabel BC, Cohen MA, Heuer GG, Pisapia J, Bohman LE, Leibowitz JM (2008) Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve. Neurosurg Focus 25(6):E10
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Felisati, G., Pipolo, C., Maccari, A. et al. Transnasal 3D endoscopic skull base surgery: questionnaire-based analysis of the learning curve in 52 procedures. Eur Arch Otorhinolaryngol 270, 2249–2253 (2013). https://doi.org/10.1007/s00405-012-2328-5
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DOI: https://doi.org/10.1007/s00405-012-2328-5