The 3-Dimensional Insect Eye Laparoscopic Imaging System - Evaluation of a Novel Technology by a Prospective Randomized Study Y. Kaufman, A. Sharon, O.

The 3-Dimensional The 3-Dimensional “Insect Eye”“Insect Eye” Laparoscopic Imaging System - Laparoscopic Imaging System -

Evaluation of a Novel Technology Evaluation of a Novel Technology by a Prospective Randomized by a Prospective Randomized

StudyStudy

Y. Kaufman, A. Sharon, O. Klein, D Spiegel, R. Oslander and A. Lissak

The Lady Davis Carmel Medical Center, Haifa, Israel

Minimally Invasive Surgery Minimally Invasive Surgery (MIS) – Time to improve(MIS) – Time to improve

1 .Safety

2. Cost

3 .Operative durations

4 .Learning curve

5 .Future applications!?

Handicaps of laparoscopic Handicaps of laparoscopic surgerysurgery

No direct visualization

Loss of haptic (active touch) perception

Movements of instruments is restricted – based on a fixed pivot point on the abdominal wall

Information for performing 3-D movements is received on a 2-D monitor

Depth perceptionDepth perception

MONOCULAR CUESMONOCULAR CUES

VisualInformation

Occulomotor Visual

Accommodation Convergence Binocular Monocular

MotionParallax

StaticCues

Interposition Size Perspective

Depth illusionDepth illusion

Depth illusionDepth illusion

Error types:– Perceptual input data (visual/haptic):

Surgeon had deliberately cut a duct thought to be a different duct

Surgeon injured an unseen duct

– Knowledge & decision making: Unorthodox strategy of surgery Performed an operation in an inappropriate

setting

– Action (technical skill)

Way LW, Stewart L, Gantert W. et al. Causes and Prevention of Laparoscopic Bile Duct Injuries. Annals of Surgery, 2003 27(4) 460-9

97%

Way LW, Stewart L, Gantert W. et al. Causes and Prevention of Laparoscopic Bile Duct Injuries. Annals of Surgery, 2003 27(4) 460-9

“Z lag”– Aligning X and Y axes before moving in the

depth Z axis

Monocular cuesMonocular cues

Optical illusions → Erroneous movements → Accidents

Decreased accuracy of movements → More ballistic correctional sub-movements → Longer operations

“Z lag” - Aligning on the X and Y axes before moving in the depth Z axis → Longer operations & smeared learning curves

3D Laparoscopic 3D Laparoscopic Imaging SystemsImaging Systems

Reduce:– Number of movements– Total distance of movements– Surgery duration

40-50%

Taffinder N, Smith SG, Huber J, et al. The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons. Surgical Endoscopy, 1999. 13(11): 1087-92

Second generation imaging Second generation imaging systemssystems

Images are different not only in angle but in color, optical distortion and sharpness

Fatigue, headache, nausea, dizziness, eye strain

““Insect eye” technologyInsect eye” technology Single video chip with 100,000s

tiny ‘eyes’ (pixels) embedded in 3x3 mm chip

Many small, slightly distorted images

image processing computer

Images divided into “left” & “right ”according to a specialized algorithm

Research with the “Insect Research with the “Insect eye” technologyeye” technology

University of Bologna, ItalyLahey Clinic, Boston, USASheba Medical Center, IsraelIchilov Medical Center, Israel

Carmel Medical Center, Israel

Benefits using the “Insect Benefits using the “Insect eye” technologyeye” technology

Reduction in operative time for experienced as well as novice surgeons

Shorter learning curve Greater satisfaction reported by the

surgeon No side effects

Operation type \ Imaging system

2-D3-D

MeanSD95% CInMeanSD95% CInΔ

BSO (n=17)4625.129.6-62.4940.412.831.5-49.38-12.2%

USO(n=8)

6352.43.7-122.3338.615.425.1-52.15-38.7%

BTL (n=6)217.513.7-28.3492.85.1-12.92-57.1%

Cystectomy (n=16)46.715.935.7-57.7834.619.321.2-488-25.9%Diagnostic laparoscopy

(n=21)27.77.622.7-32.7923.910.418-29.812-13.7%

Table 1: Surgery duration in minutes according to the type of operation and the type of imaging system used

STLH (n=9)89.823.469.3-110.3511530.385.5-144.94+28.3%

STLH + BSO (n=11)86.314.775.4-97.2790.71773.1-108.34+5.1%

0

20

40

60

80

100

120

Minutes

Resident Experiencedsurgeon I

Experiencedsurgeon II

Highlyexperienced

surgeon

2-D

3-D

n=10

n=16n=18

n=13n=16

n=16

n=4

n=3

Figure 1: Surgery duration in minutes according to the experience of the surgeon and the type of imaging system used.(n = number of subjects in each group)

0

100

200

300

400

500

cc 2-D

3-D

2-D 41.6 129 366.7

3-D 14.9 177.7 450

Easy Normal Difficult

n=34n=33

n=11

n=11

n=3

n=2

Figure 2: Amount of blood loss (in cc) according to the level of difficulty as estimated by the surgeon and to the type of imaging system used. (n = number of subjects in each group)

2.352.4

2.452.5

2.552.6

2.652.7

2.752.8

Grade of Surgeon

Satisfaction

DepthPerception

Anatomicunderstanding

ProcedureEfficiency

PhysicianConfidence

Effectiveness inComplicatedM aneuvers

2-D 3-D

Figure 3: surgeon satisfaction criteria using the 2-D vs. 3-D imaging systems (1=Insufficient, 2=Sufficient, 3=Excellent)

Benefits using the “Insect Benefits using the “Insect eye” technologyeye” technology

Reduction in operative time for experienced as well as novice surgeons

Shorter learning curve Greater satisfaction reported by the

surgeon No side effects Decreased operative durations found

mostly in shorter operative procedures

More possible benefitsMore possible benefits

Advanced performance surgery – lymph node dissection

Narrow operative fieldsIntegration with other imaging

modalities– CT image reconstruction– Intra-abdominal 3D + 4D US– “See through the tissue”

Y. Kaufman M.D¹., A. Sharon M.D. ¹., O. Klein M.D. ¹., D Spiegel M.D.², R. Auslander, M.D. ¹. and A. Lissak M.D. ¹.

The 3-Dimensional The 3-Dimensional “Insect Eye”“Insect Eye” Laparoscopic Laparoscopic Imaging System - Evaluation of a Novel Technology Imaging System - Evaluation of a Novel Technology by a Prospective Randomized Studyby a Prospective Randomized Study