• Hani J Marcus, Archie Hughes-Hallett, Thomas P Cundy, Aimee Di Marco, Philip Pratt, Dipankar Nandi, Ara Darzi, and Guang-Zhong Yang.
• *Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, United Kingdom; ‡The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
• Neurosurgery. 2014 Apr 1; 74 (4): 375-80; discussion 380-1.

BackgroundAlthough the potential benefits of 3-dimensional (3-D) vs 2-dimensional (2-D) and high-definition (HD) vs standard-definition (SD) endoscopic visualization have long been recognized in other surgical fields, such endoscopes are generally considered too large and bulky for use within the brain. The recent development of 3-D and HD neuroendoscopes may therefore herald improved depth perception, better appreciation of anatomic details, and improved overall surgical performance.ObjectiveTo compare simultaneously the effectiveness of 3-D vs 2-D and HD vs SD neuroendoscopy.MethodsTen novice neuroendoscopic surgeons were recruited from a university hospital. A preclinical randomized crossover study design was adopted to compare 3-D vs 2-D and HD vs SD neuroendoscopy. The primary outcomes were time to task completion and accuracy. The secondary outcomes were perceived task workload using the NASA (National Aeronautics and Space Administration) Task Load Index and subjective impressions of the endoscopes using a 5-point Likert scale.ResultsTime to task completion was significantly shorter when using the 3-D vs the 2-D neuroendoscopy (P = .001), and accuracy of probe placement was significantly greater when using the HD vs the SD neuroendoscopy (P = .009). We found that 3-D endoscopy significantly improved perceived depth perception (P < .001), HD endoscopy significantly improved perceived image quality (P < .001), and both improved participants' overall impression (P < .001).ConclusionThree-dimensional neuroendoscopy and HD neuroendoscopy have differing but complementary effects on surgical performance, suggesting that neither alone can completely compensate for the lack of the other. There is therefore strong preclinical evidence to justify 3-D HD neuroendoscopy.

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