jr Journal of Rhinology J Rhinol 1229-1498 2384-4361 Journal of Rhinology 10.18787/jr.2016.23.2.102 jr-23-102 Original Article Clinical Comparison of 3D Endoscopic Sinonasal Surgery Between ‘Insect Eye’ 3D and ‘Twin Lens’ 3D Endoscopes SangYeob SeongMD 1 2 SangChul ParkMD 1 HyoJin ChungMD 1 ChoHyung-JuMD, PhD 1 3 YoonJoo-HeonMD, PhD 1 3 4 KimChang-HoonMD, PhD 1 3 Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul; Yonsei Well ENT Clinic, Seoul; The Airway Mucus Institute, Seoul; Research Center for Natural Human Defense System, Yonsei University College of Medicine, Seoul, Korea Address for correspondence: Chang-Hoon Kim, MD, PhD, Department of Otorhinolaryngology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-3609, Fax: +82-2-393-0580, E-mail: entman@yuhs.ac 01 2016 10 01 2016 23 2 102 109 29032016 01082016 31082016 Copyright © 2016 Journal of Rhinology 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background and Objectives

Three-dimensional (3D) imaging is gaining popularity and has been partially used in robotic surgery but not in sinonasal surgery owing to technical problems. This is not only the first pilot study to evaluate the usefulness of newly-developed ‘twin lens’ HD-3D endoscope (Machida), but also the first clinical study to compare this instrument with the pre-existing ‘insect eye’ 3D endoscope (Visionsense).

 Materials and Method

A total of 45 surgeries for cerebrospinal fluid leakage, angiofibroma, or sinonasal malignancy were performed using a 3D endoscope between November 2011 and October 2013 (‘insect eye’ Visionsense VSII 3D: 29 cases, ‘twin lens’ Machida HD-3D: 16 cases).

 Results

Depth perception and recognition of anatomical structures were all excellent in the two 3D methods. The ‘twin lens’ HD-3D endoscope provided better image resolution and naturalness of color and showed less unfavorable phenomena such as image blurring and blackout than the ‘insect eye’ 3D endoscope.

 Conclusion

If the technical limitations are solved, the 3D endoscope will be used as a substitute and a standard tool in endoscopic sinonasal surgery rather than as supplement to the two-dimensional (2D) endoscope in the near future.

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Visionsense ‘insect eye’ VSII video tower combining with 32” high-resolution display monitor and 3D imaging processing unit (A1). 4-mm 0º, 30º 3D endoscope and cable with LED light source (A2). 40” high-definition display monitor (Sony, Tokyo, Japan), Machida ‘twin lens’ 3D video camera unit and 3D converter (B1). 4.7-mm 0º 3D endoscope consisting of twin-lens (B2). 0º, 30º 3D endoscope and xenon light cable (B3).

Left ethmoid sinus view in 2 different patients with ‘insect eye’ 3D endoscope (Visionsense) (A) and ‘twin lens’ HD-3D endoscope (Machida) (B). Reconstructed right (A1) and left (A2) images using single video chip. Separate, independent right (B1) and left (B2) images using twin lens and dual video chip.

Specification comparison of 3D endoscopes

  VSII 3D Endoscope (Visionsense, Orangeburg, NY) Machida HD-3D Endoscope (Machida, Tokyo, Japan)
Mechanism ‘Insect eye’ 3D (Single chip video camera, microscopic array of lenses) ‘Twin lens’ HD-3D (Dual chip video camera, twin lens)
Light source LED Xenon
Endoscope diameter 4 mm 4.7 mm
Angled endoscope 0º, 30º 0º, 30º
Display monitor Exclusive (32” high-resolution monitor, 1360×768 pixels) Various (compatible)
Polarizing glasses Exclusive Various (compatible)

Patients’ demographic and procedural details for ‘insect eye’ Visionsense VSII 3D endoscope

Pt Sex/ Age Diagnosis Radiologic findings Procedures Strategy Op. time (min)
1 F/57 CSF rhinorrhea (L) Lateral lamella dehiscence CSF leak repair, Septoplasty 3D+2D 160 (w/lumbar D)
2 F/54 Chronic sinusitis (R) Fungal ball in Onodi cell Endoscopic sinus surgery 3D 050
3 M/77 Chronic sinusitis (B) Severe frontal sinusitis Endoscopic sinus surgery, Septoplasty 3D+2D 090
4 M/69 Recurred olfactory neuroblastoma Nasopharynx mass Endoscopic mass excision, Posterior septectomy 3D 090
5 M/69 Sinonasal cancer (SCC) Sphenoid sinus mass Endoscopic mass excision, Posterior septectomy 3D 140
6 M/13 Recurred juvenile nasopharyngeal angiofibroma (L) Extension to sphenopalatine foramen, foramen rotundum Endoscopic mass excision 3D+2D 130
7 M/37 Mucocele (R) Sphenoid sinus mucocele Sphenoidotomy, Septoplasty 3D+ Navi 080
8 M/65 Chronic sinusitis (B) Orbital fat herniation Revision endoscopic sinus surgery 3D 080
9 F/69 Chronic sinusitis (R) Fungal ball in maxillary sinus Endoscopic sinus surgery 3D 035
10 M/54 Chronic sinusitis (B) Severe frontal osteitis Revision endoscopic sinus surgery 3D+2D 095
11 M/52 Chronic sinusitis (B) Onodi cell Endoscopic sinus surgery, Septoplasty 3D 080
12 M/45 Chronic sinusitis (B) Pansinusitis Endoscopic sinus surgery, Septoplasty 3D 120
13 M/67 Chronic sinusitis (R) Fungal ball in maxillary sinus Endoscopic sinus surgery, Septoplasty 3D 065
14 M/61 Chronic sinusitis (R) Fungal ball in maxillary sinus Endoscopic sinus surgery 3D 030
15 M/43 Chronic sinusitis (B) Type 3 Frontal cell Endoscopic sinus surgery 3D 070
16 F/44 CSF rhinorrhea (L) s/p meningioma removal – CSF leak repair 3D 130 (w/lumbar D)
17 F/57 Nasal cavity cancer (R) (ACC) – Endoscopic mass excision, Posterior septectomy 3D+ Navi 070
18 M/60 Olfactory neuroblastoma (L) Kadish stage C Craniofacial resection, Endoscopic mass excision 3D+2D 630 (w/CFR)
19 M/76 Nasal cavity cancer (L) (ACC) Stage T4a Endoscopic mass excision, Posterior septectomy 3D+ Navi 170
20 M/60 Nasal cavity cancer (R) (SCC) Stage T4a Endoscopic mass excision, Medial maxillectomy via MFDA 3D 180 (w/MM)
21 M/36 Nasal cavity schwannoma (B) – Endoscopic mass excision, Endoscopic sinus surgery 3D 080
22 M/58 Inverted papilloma (L) Ethmoid sinus origin tumor Endoscopic mass excision, Endoscopic sinus surgery 3D 050
23 M/38 Mucocele (L), CSF leakage Frontal sinus mucocele Endoscopic sinus surgery, CSF repair 3D+2D 080
24 M/42 CSF rhinorrhea s/p CCRTx – CSF leak repair 3D 120 (w/lumbar D)
    Recurred CSF rhinorrhea – CSF leak repair w/nasoseptal flap 3D 120 (w/lumbar D)
25 F/74 Inverted papilloma (L) Ethmoid sinus origin tumor Endoscopic mass excision, Endoscopic sinus surgery 3D+2D 090
26 M/54 Plasmacytoma (R) Inferior turbinate origin Endoscopic sinus surgery 3D 080
27 M/54 Inverted papilloma (L) Lamina papyracea dehiscence Endoscopic mass excision, Septorhinoplasty 3D 090 (w/SRP)
28 M/21 Recurred juvenile nasopharyngeal angiofibroma (L) Sphenopalatine foramen origin Mass excision via endoscopic approach and sublabial approach 3D 190 (w/sublabial app.)

Pt: patient, Op.: operation, Navi: navigation, L: left, R: right, B: both, CSF: cerebrospinal fluid, CCRTx: concurrent chemoradiation, SCC: squamous cell carcinoma, CFR: craniofacial resection, MM: medial maxillectomy, MFDA: midfacial degloving approach, w/: with, lumbar D: lumbar drainage, SRP: septorhinoplasty

Patients’ demographic and procedural details for ‘twin lens’ Machida HD-3D endoscope

Pt Sex/ Age Diagnosis Radiologic findings Procedures Strategy Op. time (min)
1 F/52 Mucopyocele (R) Sphenoid sinus anterolateral wall dehiscence Sphenoidotomy 3D 30
2 M/51 Sinonasal malignant melanoma (L) – Endoscopic mass excision, Endoscopic sinus surgery 3D 50
3 F/18 Chronic sinusitis (B) – Endoscopic sinus surgery, Septoplasty 3D 80
4 M/79 Inverted papilloma (L) Ethmoid sinus origin Endoscopic sinus surgery 3D+2D 50
5 F/23 Mucocele (L) Petrous apex origin Endoscopic marsupialization 3D+ Navi 470 (w/ Tympano.)
6 M/60 Chronic sinusitis (B) – Endoscopic sinus surgery, Septoplasty 3D 80
7 F/35 Chronic sinusitis (B) – Endoscopic sinus surgery, Septoplasty 3D 60
8 M/45 Chronic sinusitis (R) – Endoscopic sinus surgery, Septoplasty 3D 70
9 M/36 Petrous meningioma (L) Temporo-petrous-sphenoid sinus mass Endoscopic mass excision, Endoscopic sinus surgery 3D 930 (w/NS)
10 M/53 Recurred inverted papilloma (L) Lamina papyracea origin Endoscopic mass excision, Endoscopic sinus surgery, Septorhinoplasty 3D 120 (w/SRP)
11 M/36 Nasal cavity Myofibroblastic Sarcoma (R) – Mass excision via endoscopic approach and canine fossa approach 3D 80 (w/canine fossa app.)
12 M/26 Foreign body materials in retromaxillary area (R) Fibrous calcification Endoscopic mass excision 3D+ Navi 110
13 M/37 Chronic sinusitis (L) Type 4 frontal cell Endoscopic sinus surgery, Septoplasty 3D+2D 80
14 M/80 Nasal cavity cancer (L) (SCC) Maxillary sinus origin, Stage T3 Endoscopic mass excision, Medial maxillectomy via MFDA 3D 150 (w/MM)
15 F/36 Mucocele (L) Frontal sinus origin Endoscopic sinus surgery 3D 30
16 M/53 NK-T cell lymphoma   Endoscopic biopsy 3D 50

Tympano: tympanoplasty, NS: neurosurgery department

Causes of switch from 3D to 2D endoscope

‘Insect eye’ VS II 3D patients Causes
1 Overmagnification, Blurred vision when blood soiled
3 Not enough high-angled view (for frontal sinus view)
6 Blurred vision when blood soiled
10 Not enough high-angled view (for frontal sinus view)
18 Overmagnification, Not enough high-angled view
23 Overmagnification, Blurred vision when blood soiled
25 Not enough maxillary sinus view (for inverted papilloma)
‘Twin lens’ machida HD-3D patients Causes
4 Not enough maxillary sinus view (for inverted papilloma)
5 Not enough high-angled view (for type 4 frontal cell)

Comparison of qualitative assessments for 3D endoscopes

  ‘Insect eye’ 3D (visionsense VSII) ‘Twin Lens’ HD-3D (machida)
Endoscope diameter Smaller (4 mm) 4.7 mm
Depth perception Similar
Image resolution   Superior
Naturalness of color   Superior
Overmagnification   Superior
Blurred image when blood soiled   Superior
Blackout by reflected light   Superior
Brightness Superior