Video Learning of Surgical Procedures: A Randomized Comparison of Microscopic, 2- and 3-Dimensional Endoscopic Ear Surgery Techniques

Abstract

BackgroundVideo learning of surgical procedures helps trainees gain an initial understanding of the complex anatomy and the surgical procedure. Because no comparative studies have yet examined which microsurgical approach to the middle ear is most suitable for video learning, the authors investigated objective and subjective outcomes for medical trainees observing microscopic, 2-dimensional (2D) endoscopic, and 3- dimensional (3D) endoscopic ear surgeries.MethodsSixty-two medical students (min. 3rd year) from the University Hospital of Bern watched three standardized videos of a type I tympanoplasty surgery recording, conducted with a microscope, a 2D endoscope, and a 3D endoscope, respectively. The authors measured participants’ learning outcome, eye movements, cognitive load, and subjective preferences.ResultsOf the 62 participants included in the study, 14 were male (22.58%), and mean age was 24.44 years (range: 21–29). Learning outcome was highest after watching the 3D endoscopic video (mean [SD], 59.48% [20.57%]). Differences in score were statistically significant: 2D endoscopic video (mean difference: –6.56%, 95% CI: –13.02 to –0.10%), microscopic video (mean difference: –13.82%, 95% CI: –20.27 to –7.36%). Participants showed lowest average eye fixation duration when watching the 3D endoscopic video (mean [SD], 307 ms [109 ms]), with statistically significant differences to the 2D endoscopic video (mean difference: –139 ms, 95% CI: –185 to –93 ms), and the microscopic video (mean difference: –264 ms, 95% CI: –310 to –218 ms). Participants reported lowest cognitive load for the 2D and 3D endoscopic videos. Ratings on discomfort, usability, naturalness, depth perception, and image quality were in favor of the 3D endoscopic video.ConclusionThe 3D endoscopic technique offers many advantages for video learning in terms of knowledge gain, visual field exploration, and subjective evaluation. To optimize learning effects in trainees, the authors recommend the use of endoscopes in middle ear surgery and, if available, using 3D technology.

Outcomes After Exoscopic Versus Microscopic Type 1 Tympanoplasty

“…In a study comparing the microscope to 2D and 3D endoscopic technology, the learning outcomes were highest after watching the 3D endoscopic video. Ratings on discomfort, usability, naturalness, depth perception, and image quality were also in favor of the 3D endoscopic video (13). While not yet extensively studied, these 3D benefits may extend to 3D exoscopic technology.…”

Eyes and Movement Differences in Unconscious State during Microscopic Procedures

“…The time required for training for safety quality checks in corporate manufacturing lines and construction sites can be signi cantly reduced by providing feedback on eye movement results [8] . In the eld of medicine, compared to novices, skilled operators perform tasks during head and neck 3D endoscopic surgery within a narrower range of starting times and places, possibly because the conversion of interpretation from 2D to 3D is empirically unnecessary for skilled operators [9] .…”

Training and proficiency level in endoscopic sinus surgery change residents’ eye movements

“…Completion time in minutes was measured for each session. After every session, participants indicated their perceived cognitive load during the surgery with the NASA-TLX 13,[20][21][22] , a self-report measurement consisting of six subscales, each ranging from 0 to 100.…”