3d optics - duke university · 3d optics todd l. demmy . no disclosures ... binocular cameras . ......

Masters MITS '2015

3D Optics

Todd L. Demmy

No Disclosures

5/13/15

Masters MITS '2015

SBRT

Masters MITS '2015

SBRT

• Least invasive

• Allows surgical

bail-out later

Masters MITS '2015

Pietrabissa, Surg Endosc DOI 10.1007/s00464-015-4185-y

From CT scanning to 3-D printing technology for the

preoperative planning in laparoscopic splenectomy

Masters MITS '2015

Pietrabissa, Surg Endosc DOI 10.1007/s00464-015-4185-y

• Post-processing analysis 2 hours.

• Printing time 20 hours each model.

• 4 additional hours to finalize each object.

• 300 euros.

• High Satisfaction marks

From CT scanning to 3-D printing technology for the

preoperative planning in laparoscopic splenectomy

Masters MITS '2015

Medical Titanium 3D Printing

http://www.gizmag.com/go/6657/

Masters MITS '2015

Navigational Bronchoscopy

Ann Thorac Surg 2008;85:797-801

Masters MITS '2015

Adv Opt Photonics. 2013 ; 5(4): 456–535. doi:10.1364/AOP.5.000456.

Three-dimensional display technologies

Depth Cues From 3D Devices

Masters MITS '2015


Linear Perspective “Trick”

Masters MITS '2015



Masters MITS '2015

Lee, JOURNAL OF LAPAROENDOSCOPIC & ADVANCED

SURGICAL TECHNIQUES Volume 23, Number 7, 2013 561-9

Performing Task 3

under infrared

illumination

Inexpensive method to improve laparoscopic

depth perception. However, subjects needed to

pay special attention to the shadows

Dynamic Shadowing on 2D and 3D Laparoscopic

Visualization Under Visible Light and Infrared Light

Masters MITS '2015

Shadow Telescope

Masters MITS '2015



Masters MITS '2015

New 3D Viewing

Technology

Masters MITS '2015



Masters MITS '2015

Needlescope

Masters MITS '2015

Visualization Tools

High Definition Optimal

Masters MITS '2015

Common 3D Systems today

Olympus ENDOEYE Flex

3D Laparoscopy

Viking Intuitive 3D + Robotic Laparoscopy

ConMed.com

bbraun.com

Masters MITS '2015

Binocular Cameras

Masters MITS '2015

3D System Basic Configuration

LMD-2451MT/3G4

3DV-190

CV-190

CV-190

CLV-190

LTF-190-10-3D

Masters MITS '2015

• Dimmer than 2D images

• Glasses were heavy, uncomfortable and

decidedly “un-cool”

• Scope and camera heads were heavy and bulky

• Prohibitively expensive

• Sterilization was a challenge

• 3D was essentially a novelty

• No independent scope rotation was possible

(loss of visual horizon)

3D Laparoscopy Historical Review

Some problems associated with previous 3D systems…

SP0582V01

Masters MITS '2015

3DSCOPE (American Surgical Technologies

Corporation, Chelmsford, MA, U.S.A.)

"passive" eyewear

“Our results suggest

that first-generation 3-D

video systems offer no

significant advantage to

the novice or expert

surgeon performing

laparoscopic

procedures.”

Masters MITS '2015

Jones Surgical Laparoscopy & Endoscopy Vol.,6 (3)

1996, 191-197

"'More

control

"

in 3-D

(%)

Prefer 3-D

(%)

Students (n = 10) 60 30

Residents (n = 10) 60 50

Attending surgeons

(n = 10)

60 60

Overall 60 47

2-D % 3-D %

Poor

lighting

3 53

Headache 0 3

Nausea 0 0

Eye strain 0 17

Other

problems

0 0

1996 Generation 3D

Masters MITS '2015

1997 Time taken for the task in relation to the

laparoscopic experiences of participants

Time taken Number 2D

Olympus

OTV-S4

3D

Baxter-V.

Mueller VS7700

Signed-rank

test

All 32 659.1 ± 388.1 638.2 ± 387.1 p = 1.0

With experience 11 488.7 ± 230.0 443.8 ± 242.7 p = 0.6

without Mann-Whitney U test

21 748.4 ± 427.4 p = 0.05

740.0 ± 413.8 p = 0.03

p = 0.9

Chan, Surg Endosc (1997) 11: 438–440

We could not demonstrate any superiority of the 3D system over the 2D

system. However, two-thirds of the surgeons commented that the depth

perception did improve

Compared to human eyes which have an interpupillary distance 60 mm or

more, the two distal mounted cameras in the laparoscope are only separated

by 10 mm.

Masters MITS '2015

Patel UROLOGY 70: 47–49, 2007

2007 - Is It Worth Revisiting Laparoscopic Three-

Dimensional Visualization?

A Validated Assessment

The laparoscopic system we used

can switch between two and

three dimensions (Viking

EndoSite, Viking Systems, LaJolla,

Calif). stereo digital

scope (dual 3CCD optical channel)

15 Novices vs. Two

Experts

Masters MITS '2015

Patel UROLOGY 70: 47–49, 2007

2007 - Is It Worth Revisiting Laparoscopic Three-

Dimensional Visualization?

A Validated Assessment

Masters MITS '2015

High Definition Laparoscopy: Objective Assessment of

Performance Characteristics and Comparison with Standard

Laparoscopy

Pierre, JOURNAL OF ENDOUROLOGY,

Volume 23, Number 3, March 2009, p. 523-528

• Olympus SD laparoscope has a

standard rodlens with a camera

head and light source separate

from the lens itself.

• The Olympus HD laparoscope

uses the "chip on a stick" or "chip

in tip" design

Masters MITS '2015





Laparoscopy

Masters MITS '2015





Laparoscopy

Better

Depth

of

Field

Masters MITS '2015



Optical

characteristic

HD

laparoscope

SD

laparoscope Resolution (line pairs/mm) 2.4 2.0

Distortion (%) 4 10

Depth of field (relative to

focal point)

>45mm 12mm

Brightness (lumens) 129 11.2

Color reproduction Similar to SD Similar to HD

Grayscale discernment Similar to SD Similar to HD



Laparoscopy

Masters MITS '2015

Taffinder, Surg Endosc (1999) 13: 1087–1092

1999 - Effect of a second-generation 3D endoscope on the

laparoscopic precision of novices and experienced surgeons

Surgical Vision, Reading, UK, (c) 3D, 2nd generation

Masters MITS '2015

Taffinder, Surg Endosc (1999) 13: 1087–1092

• 2D endoscopic vision impaired performance by 35–100% when compared with direct vision,

• 3D reduced this endoscopic handicap by 41–53% in novices and experienced surgeons (p < 0.03).

• No side effects were reported with the new 3D system.

• Even in 2D, novices performed better with an image at arm’s length (p < 0.03).

1999 - Effect of a second-generation 3D endoscope on the

laparoscopic precision of novices and experienced surgeons

Masters MITS '2015

Surg Endosc (2000) 14:71-74

The evaluation did not show a significant (p > 0.05)

difference in performance time in all models, but there was

a clear trend showing the benefit of a higher resolution.

2000 High Definition Imaging

Masters MITS '2015

2007 - Performance differences in laparoscopic surgical

skills between true HD and 3-chip CCD video systems

Hagiike, Surg Endosc (2007) 21:1849–1854

SD system consisted of a three-chip CCD

camera (720 · 480 pixels, interlace, 4:3 aspect

ratio)

WideView HD monitor, 1,920 · 1,200 pixels,

progressive, 16:10 aspect ratio; Karl Storz

Inc. Culver City, CA, USA).

VS.

Masters MITS '2015

Hagiike, Surg Endosc (2007) 21:1849–1854

Knot tying 173 ± 84 s vs

214 ± 107 s; p = 0.003

2007 - Performance differences in laparoscopic surgical

skills between true HD and 3-chip CCD video systems

Masters MITS '2015

Feng, Surg Endosc (2010) 24:2743–2748

2010 - A computerized assessment to compare the impact

of standard, stereoscopic, and high-definition

laparoscopic monitor displays on surgical technique

2D system, we used a Karl Storz

Endoscopy 0 telescope, a charge-coupled

device (CCD) camera, a light source, and

a 15-inch cathode-ray tube (CRT)

monitor.

HD system, we used a Karl Storz

Endoscopy HD camera, and replaced the

CRT monitor with a 1080p HD liquid-

crystal display (LCD) monitor [8].

3D system, we used stereovision camera

(Welch Allyn Inc., Skaneateles Falls, NY),

a ViewSonic 17-inch CRT monitor, and a

pair of 3D goggles

The study demonstrates that, while users expressed a decided preference for HD systems,

actual quantitative analysis indicates that HD monitors offer no statistically significant

advantage and may even worsen performance compared with standard 2D or 3D

laparoscopic monitors.

Masters MITS '2015

Feng, Surg Endosc (2010) 24:2743–2748




Masters MITS '2015

Feng, Surg Endosc (2010) 24:2743–2748




“DEPTH”

“TEXTURE”

“NATURAL”

Masters MITS '2015

Autostereoscopic devices

Geometrical solution keeps the

images separate for each eye.

Entertainment market has greatly

invested in autostereoscopic

displays.

For example:

Nintendo DS

Microsoft autostereoscopic

prototype

Sharp 3D glass-free monitor

Silvestri, Surgical Innovation 2011 18(3) 223–230

Autostereoscopic 3-D Viewer Evaluation Through

Comparison With Conventional Interfaces in Lap. Surgery

Masters MITS '2015

19-inch (1280 × 1024) AM24 (Pavonine Korea Inc,

eMagin Z800, SVGA resolution

(800 × 600 pixels) on organic light

emitting diode panels

Silvestri, Surgical Innovation 2011, 18(3) 223–230

2011 - Autostereoscopic 3-D Viewer Evaluation Through


VS.

Masters MITS '2015

Silvestri, Surgical Innovation, 2011, 18(3) 223–230



Masters MITS '2015

22% Faster 60% Preferred User

Friendliness

Silvestri, Surgical Innovation 2011, 18(3) 223–230



VS.

Masters MITS '2015

American Journal of Surgery 193 (2007) 519–522

2007 - Three-dimensional imaging improves surgical

performance for both novice and experienced operators

using the da Vinci Robot System

Masters MITS '2015

LAGRANGE, JOURNAL OF ENDOUROLOGY, Volume 22,

Number 3, March 2008

2008 - Evaluation of Three Different Laparoscopic Modalities:

Robotics versus Three-Dimensional Vision Laparoscopy versus

Standard Laparoscopy

• Improved performance using three-

dimensional optics on some tasks, but not a

significant improvement in overall results.

• 3D vision beneficial during performance of

some complex tasks.

• The wrist-like action of the robot improved

performance on some tasks, while the lack of

tactile feedback likely was a source of errors

on other tasks

Standard laparoscopy with two-dimensional cameras, the 3Di

Endosite visual system, and the da Vinci Robotic Surgical System

Masters MITS '2015






3D Beats Robot

Masters MITS '2015






Robot wins

Masters MITS '2015

Votanopoulos,World J Surg (2008) 32:110–118

2008 Impact of Three-Dimensional Vision in

Laparoscopic Training

No Difference

Masters MITS '2015


3month later



Masters MITS '2015


On 2D System – former 3D 181

sec total task time lower than

those “trained” on 2D

P=0.002

On 3D System – former 2D only

10 sec total task time lower than

those “trained” on 3D

P=0.84



Masters MITS '2015

2015 An assessment of the new generation three-

dimensional high definition laparoscopic vision system

on surgical skills: a randomized prospective study

Usta, Surg Endosc (2015) 29:2305–2313

3D LVS where polarized glasses are used, images are

simultaneously relayed to the monitor at various angles.

Each one of the polarized glasses conducts the image to

each eye separately.

Viking 3D HD LVS, displayed to the corresponding

eye by special filter glasses using micropolarization technology

Masters MITS '2015

Usta, Surg Endosc (2015) 29:2305–2313

2015 An assessment of the new generation three-

dimensional high definition laparoscopic vision system

on surgical skills: a randomized prospective study

Masters MITS '2015

2010 - Comparison of two- and three-dimensional

camera systems in laparoscopic performance: a novel

3D system with one camera

Kong, Surg Endosc (2010) 24:1132–1143

About 54% of the novices and 80% of the

experienced surgeons preferred the 3D system.

Electromyography (EMG) showed a tendency

toward less usage of the right arm and more

usage of the left arm with the 3D system.

Masters MITS '2015

2010- Comparison of two- and three-dimensional



Kong, Surg Endosc (2010) 24:1132–1143

it uses a novel one-camera mechanism to change the path of light

using the difference in density between objects (Fig. 1)

Masters MITS '2015

Kong, Surg Endosc (2010) 24:1132–1143

2010- Comparison of two- and three-dimensional



Masters MITS '2015

2015 Three-dimensional (3D) simulation versus two-dimensional

(2D) enhances surgical skills acquisition in standardised

laparoscopic tasks: A before and after study

International Journal of Surgery 14 (2015) 12e16

Laparoscopic simulators (Laprotrain©)

were used attached to a 2D and a simulated 3D

monitor (Sony

BRAVIA TV) respectively

Masters MITS '2015

International Journal of Surgery 14 (2015) 12e16

• Tasks completed faster in the 3D group compared with the 2D

group.

• There was a lower rate of errors noted in the 3D group compared

with the 2D group but this only reached statistical significance in

two of the five laparoscopic tasks.

• In the crossover study, subjects who had trained on simulated 3D

had better task times and fewer errors compared to those who had

trained on 2D simulators.

4.2. Errors

Although there was an overall trend to reduced numbers of

errors in the 3D group, this was only significant in tasks 4 and 5.

[Table 5]

4.3. Crossover study

Interestingly, when the groups were switched, subjects who had

trained on the 3D simulator had faster 2D task times compared

to those who trained on the 2D simulator in three of the tasks.

[Table 6]

2015 Three-dimensional (3D) simulation versus two-dimensional

(2D) enhances surgical skills acquisition in standardised

laparoscopic tasks: A before and after study

Masters MITS '2015

Surg Endosc DOI 10.1007/s00464-015-4189-7

• Overall, 3D laparoscopy appears to improve speed

and reduce the number of performance errors when

compared to 2D laparoscopy.

• Most studies to date assessed 3D laparoscopy in

simulated settings, and the impact of 3D laparoscopy

on clinical outcomes has yet to be examined.

Masters MITS '2015

2014 - Effect of passive polarizing three-dimensional displays on

surgical performance for experienced laparoscopic surgeons

Smith, BJS 2014; 101: 1453–1459

• Passive polarizing 3D displays

improved both the performance of

experienced surgeons in a

simulated setting and surgeon

perception of the operative field.

• Although it has been argued that

the experience of skilled

laparoscopic surgeons

compensates fully for the loss of

stereopsis, this study indicates that

this is not the case.

Masters MITS '2015

2015 - Is a robotic system really better than the 3D laparoscopic

system in terms of suturing performance?: comparison among

operators with different levels of experience

Park, Surg Endosc DOI 10.1007/s00464-015-4357-9

• Novices benefited particularly from the robot.

• The intermediate group completed the task equally well and

equally quickly with 3D laparoscopy and the robot.

• The experts completed the task equally well regardless of

instrument, but their times were much faster with 3D laparoscopy.

• Thus, well-trained laparoscopic surgeons may not really benefit

from 3D robot systems if 3D laparoscopy is available.

• 2D imaging system (ENDOEYE FLEX

System, Olympus, PA, USA

• ENDOEYE FLEX 3D System (Olympus,

PA, USA) was used for 3D laparoscopy

• experts (>100 lap. cases, n = 9)

• intermediate (20–99 cases, n = 7)

• novices (<20cases, n = 4).

20 Surgeons:

Masters MITS '2015

Park, Surg Endosc DOI 10.1007/s00464-015-4357-9

2D laparoscope

(%)

3D laparoscope

(%)

3D robot (%) P valuea

Novice (n = 4, 12

attempts)

12 (100) 12 (100) 0 <0.001

Intermediate (n =

7, 21 attempts)

5 (23.8) 1 (4.8) 0 0.040

Expert (n = 9, 27

attempts)

2 (7.4) 1 (3.7) 0 0.769

Table 1 Task failure rates of the three surgeon groups with the three instruments

2D

laparoscope

3D

laparoscope

3D robot p

Total completion

time

244 (155, 270) 177 (126, 217) 233 (187, 461) 0.010

First stitch and

tying

82 (52, 116) 60 (36, 91) 86 (51, 139) 0.016

Running suture 83 (50, 100) 68 (75, 244) 120 (75, 244) 0.001

Final tying 64 (47, 104) 42 (27, 108) 33 (24, 112) 0.107

2015 - Is a robotic system really better than the 3D laparoscopic

system in terms of suturing performance?: comparison among

operators with different levels of experience

Masters MITS '2015

2012 - Three-dimensional vision enhances task

performance independently of the surgical method

Wagner,Surg Endosc (2012) 26:2961–2968

N=34, half inexperienced

The more complex the task,

the more 3D vision

accelerates task completion

compared with 2D vision.

The gain in task

performance is independent

of the surgical method.

Masters MITS '2015

Wagner,Surg Endosc (2012) 26:2961–2968

2012 - Three-dimensional vision enhances task

performance independently of the surgical method

Masters MITS '2015

Khoshabeh, IEEE TRANSACTIONS ON BIOMEDICAL

ENGINEERING, VOL. 59, NO. 10, OCTOBER 2012

2012 - Multiview Glasses-Free 3-D Laparoscopy

Masters MITS '2015

Stereoscope3-D camera (8190; Vista Medical Technologies,

Westborough,MA) coupled with the 3-D 30/70-degree

Stereoscope(8191-2; Vista Medical Technologies).

2000 Three-Dimensional Video-Assisted Thoracoscopic

Pericardiectomy

Surgical team wearing

Cardioview head-

mounted displays

with Vista console to

the far left. Vista 3-D

scope and camera

head shown in inset

Luison, Ann Thorac Surg 2000;70:2137– 8

Masters MITS '2015

2015 Complete thoracoscopic lobectomy for cancer:

comparative study of three-dimensional high-definition

with two-dimensional high-definition video systems†

Bagan , Interactive CardioVascular and Thoracic Surgery 20

(2015) 820–824, doi:10.1093/icvts/ivv031

• N=18

• randomized 2D-HD or 3D-HD system

• same surgeon

Masters MITS '2015

Bagan , Interactive CardioVascular and Thoracic Surgery 20

(2015) 820–824, doi:10.1093/icvts/ivv031

Operative blood loss (ml) 238 216 0.74

Morbidity (n) 1 1 -

Mortality (n) 0 0 -

Drainage duration (days) 4.5 3.9 0.2

Lymph node station (mean) 4.5 5.3 0.1

Number of upstaging (n) N1 (1) N1 (2) 0.8

N2 (1) N2 (0) 0.5

Characteristics Group 2D (n = 9)

Group 3D (n = 9)

P-values

Age (mean) 64.1 70 0.3

Sex (M/F) 7/2 7/2 –

FEV1 (mean %) 76 104 0.16

DLCO (mean %) 59 67 0.007

Operating theatre duration time (min)

176.5 145.8 <0.001




Masters MITS '2015

Bagan , Interactive CardioVascular

and Thoracic Surgery 20 (2015)

820–824,

doi:10.1093/icvts/ivv031




Masters MITS '2015

2015 - High-definition resolution 3-D imaging systems in

laparoscopic radical prostatectomy: randomized comparative

study with high-definition resolution 2-D systems

Kinoshita, Surg Endosc (2015) 29:2203–2209

Olympus 3D laparo-thoraco videoscopes, Polarized glasses

Masters MITS '2015





Masters MITS '2015


Using a 3D imaging system in LRP

may have only limited advantages in

decreasing operation times over 2D

imaging systems. However, the 3D

system increased surgical feasibility

and decreased surgeons’ effort

levels without inducing significant

fatigue.




Masters MITS '2015

2015 - Three-Dimensional (3D) Versus Two-Dimensional

(2D) Laparoscopic Bariatric Surgery: a Single-Surgeon

Prospective Randomized Comparative Study

Currò, OBES SURG DOI 10.1007/s11695-015-1674-

y

N=52

standard five-port laparoscopic

Technique for MGBypass, 4 for Sleeve Gastrectomy

KARL STORZ 3D Camera System

3D imaging seems to decrease the

performance time of more difficult

bariatric procedures, which involve

surgical tasks as suturing and

intestinal measurement.

Masters MITS '2015

http://www.technology.org/2015/08/24/laparoscopy-to-be-

revolutionized-by-wireless-microcamera-clusters/

Wireless Multi-view

Cameras

Masters MITS '2015

Conclusions

• 3D optics are evolving, benefits all surgeons

for certain tasks, and particularly helps

trainees.

• High Def 2D beats low Def 3D, but having

both is optimal.

• The relative benefit for clinical use,

particularly straight-forward operations is

uncertain and has to be weighed against

other factors such as cost and camera size.

Masters MITS '2015

Feng, Surg Endosc (2010) 24:2743–2748

Monitor

Mean Std

error

Movement economy Scale: 0 (0%) to

1 (100%)

HD 0.6676 0.0177

3D 0.7511 0.0186

2D 0.7612 0.0187

Average speed

(inch/s)

HD 1.332 0.0747

3D 1.549 0.0749

2D 1.412 0.0748

Time consumed

(ms)

HD 19,205 1,050.03

3D 13,616 1,084.18

2D 14,691 1,075.42




Masters MITS '2015

Alaraimi, World J Surg (2014) 38:2746–2752

Masters MITS '2015

Three-Dimensional (3D) Versus Two-Dimensional (2D) Laparoscopic Bariatric Surgery: a

Single-Surgeon Prospective Randomized Comparative Study

Currò, OBES SURG DOI 10.1007/s11695-015-1674-

y

N=52

standard five-port laparoscopic

Technique for MGBypass, 4 for Sleeve Gastrectomy

KARL STORZ 3D Camera System

Mean

operative time

(minutes)

p

2D imaging

group (n=10

for SG and 10

for MGB)

3D imaging

group (n=10

for SG and 10

for MGB)

Sleeve

gastrectomy 1. First task (Bgreater curvature

ligament division^)

20 (12–22 16 (10–20) 0.08

2. Second task (Bsleeved gastric

tube formation^)

35 (24–41) 32 (19–38) 0.1

Complete procedure 72 (45–80) 68 (45–76) 0.1

Mini-gastric bypass

1. First task (Bsleeved gastric

tube formation^)

15 (10–18) 14 (10–17) 0.06

2. Second Task

(Bgastrojejunostomy

construction^)

20 (15–30) 15 (10–20) 0.02

3. Third task (Bstoma suturing^) 12 (10–21) 10 (8–16) 0.02

Complete procedure 100 88 0.03

3D imaging seems to decrease the

performance

time of more difficult bariatric procedures,

which involve surgical

tasks as suturing and intestinal measurement.

3d optics - duke university · 3d optics todd l. demmy . no disclosures ... binocular cameras . ......

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