Impact of three-dimensional heads-up display on surgical performance, ergonomics and teaching in vitreoretinal surgery: first African study

Purpose

To assess the impact of a Three-Dimensional (3D) Heads-Up Display (HUD) compared to a conventional microscope (COVM) on surgical performance, ergonomics, and teaching in vitreoretinal (VR) surgery.

Design

A single-center, retrospective cohort study and cross-sectional survey.

Methods

Surgical assistants (N = 12) and Vitreoretinal Surgeons (N = 2) were asked, in the survey arm, to complete a questionnaire regarding various parameters related to ergonomics, quality of visualization, quality of teaching, and overall satisfaction. Parameters were rated on a scale from 1 to 10 for both the 3DHUD and COVM visualization systems (VS). The scores of the two groups were compared using appropriate statistical tests. The retrospective arm of the study included 34 consecutive cases that underwent vitrectomy with the 3DHUD VS compared to 32 matched controls with the COVM. Demographics and preoperative, intraoperative, and postoperative clinical parameters were identified in both groups and were compared using appropriate statistical tests.

Results

Survey scores were significantly higher in the 3DHUD VS group when compared to the COVM VS group for both Surgeons and Assistants regarding ergonomic parameters (overall comfort (p < 0.001), neck pain (p < 0.001), and lower back pain (p < 0.001)), visualization parameters (overall visibility (p < 0.001), visibility of the macula (p < 0.001), depth of field (p < 0.001), and quality of magnification (p < 0.001)) and teaching parameters (understanding of surgical steps by assistants (p < 0.001) and teaching to medical students and residents (p < 0.001)). Both demographics and clinical data of cases operated with the 3DHUD VS and COVM VS were comparable (p > 0.05). Anatomical and functional outcomes were similar in both groups (p > 0.05); nevertheless, mean surgical time was significantly longer in the 3DHUD group for tractional retinal detachments (p < 0.001), epiretinal membranes, and phacofragmentation (p = 0.03).

Conclusion

3DHUD greatly enhances ergonomics during vitreoretinal surgery and represents a significant innovation in the teaching armamentarium within the operating room. It provides the same surgical view for both the surgeons and assistants with an unparalleled image quality. A learning curve and an integrated ecosystem may be necessary to maximize its potential and reduce surgical time.