Endoscopic endonasal surgery: How high-3D image impact our judgment and actions

Endoscopic endonasal surgery has gained popularity in recent years owing to the availability of panoramic and angled surgical views. Additionally, the introduction of high-definition (HD) imagery with 2D endoscopes has enabled acquisition of clearer images in the surgical view. However, despite these advantages, lack of a stereoscopic view is a drawback of 2D endoscopic surgery. Development of 3D endoscopies is an innovative technical advancement that addresses this limitation. The most widely used 3D endoscopy system in the world is Visionsense VSiii (Visionsense, Philadelphia, PA), which was first used in Japan last year. However, we have begun to use a new 3D HD neuroendoscopy system (Machida Endoscopes) that was developed in Japan; this system has already been used in more than 50 endoscopic endonasal surgeries. We determined that the stereoscopic view offered by 3D endoscopies is useful during bone drilling and suprasellar manipulation. Many publications have shown no significant difference in surgical outcomes between 2D and 3D endoscopic surgery, thereby making it difficult to assess the clinical significance of 3D endoscopic surgery objectively. However, there is a consensus that 3D endoscopic surgery shortens the learning curve for surgeons. Recently, a 3D conversion technique from conventional 2D images has been developed. Both 3D imaging techniques (3D endoscopy and 3D conversion) for endonasal endoscopic surgery will aid in assessing intraoperative judgment and performing certain operative maneuvers.