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