Using a high-definition stereoscopic video system to teach microscopic surgery

Introduction: While there is an increasing demand for minimally invasive operative techniques in Ear, Nose and Throat surgery, these operations are difficult to learn for junior doctors and demanding to supervise for experienced surgeons. The motivation for this study was to overcome teaching obstacles during microscopic surgical training by the use of high-definition (HD) stereoscopic video monitoring. Material and methods: We attached a 1280x1024 HD stereo camera (TrueVisionSystems Inc., Santa Barbara, CA, USA) to an operating microscope. The stereoscopic live image was displayed by two LCD projectors @ 1280x768 pixels on a 1,25m rear-projection screen by polarized filters. While the junior surgeon performed the surgical procedure based on the displayed stereoscopic image, all other participants (senior surgeon, nurse and medical students) shared the same stereoscopic image from the screen. Results: Fine adjustments required about 10 to 15 minutes before each operation. Five major effects were obtained: A) HD resolution avoided the need for direct look through the microscope’s binocular tubes. B) Stereoscopy facilitated orientation for the junior surgeon as well as for medical students. Stereoscopy helped the junior surgeon specifically to find the correct surgical plane. C) The stereoscopic image served as an unequivocal guide for the senior surgeon to demonstrate the next surgical steps to the junior colleague. D) The theatre nurse shared the same image, anticipating the next instruments which were needed. E) Medical students instantly share the information given by all staff and the image, thus avoiding the need for an extra teaching session. Conclusion: In this context, for the first time stereoscopic video in high definition resolution has been used to replace direct microscopic view to perform surgical interventions in Otorhinolaryngology. The system bears the potential to compress the learning curve for undergraduate as well as postgraduate medical professionals in minimally invasive surgery. Further studies will focus on the long term effect for operative training as well as on post-processing of HD stereoscopy video content for off-line interactive medical education.