OWN EXPERIENCES IN THE APPLICATION OF INTRAOPERATIVE 3D SPATIAL IMAGING IN THE ENDOSCOPIC SURGERY OF THE PARANASAL SINUSES
Authors:   Military Institute of Aviation Medicine, Warsaw, Poland, Wojdas Andrzej , Stablewski Roman ,   Military Institute of Aviation Medicine, Warsaw, Poland
Published: April 2023

Introduction: Intraoperative spatial imaging using a high-resolution 3D camera is a state-ofthe-art technique applied to endoscopic paranasal sinus surgery. It enables better visualization of the surgical site, improves depth perception and facilitates tissue identification. All 3D endoscopy capabilities are still under review. The purpose of this study is to compare analogous endoscopic surgeries performed with 3D technique and those performed with traditional 2D technique based on the analysis of length of surgery, blood loss, occurrence of intraoperative complications and hospital stay time. Material: The material included 346 patients who underwent endoscopic paranasal sinus surgery with unilateral or bilateral sinus opening. In case of 152 patients, corrective surgery of the nasal septum was additionally performed. The patients were divided into two groups (2D group and 3D group) comprising 173 patients each, who underwent paranasal sinus opening using 2D and 3D endoscopic visualization. Each group was divided into four subgroups: the first were patients after bilateral paranasal sinus surgery (PSS), the second were patients after bilateral endoscopic paranasal sinus surgery and nasal septal correction surgery (PSS+NS), the third were patients after unilateral paranasal sinus surgery (UPSS), and the fourth group was patients after unilateral endoscopic paranasal sinus surgery and nasal septum correction surgery (UPSS+NS). Methods: The surgery was carried out using a TipCam 3D endoscope from Storz (Germany), 18 mm in length, 4 mm in diameter, with 30° optics, with an integrated camera capable of transmitting 3D images, as well as classic 2D endoscopes, 16 mm in length, 4 mm in diameter and 30° optics, along with a video track and instrument set. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Results: The length of surgery were as follows in the 2D group: 2D/PSS+NS group — 107 min. (±22); 2D/PSS group — 95 min (±24); 2D/UPSS+NS group — 68 min (±21); 2D/UPSS group — 53 min (±14); The length of surgery in the 3D group: 3D/PSS+NS group — 91 min. (±17); 3D/PSS group — 83 min (±20); 3D/UPSS+NS group — 69 min (±15); 2D/UPSS group — 49 min (±10); Among the complications were early and late postoperative bleeding, eyelid or orbital hematomas, and eyelid edema. There were 17 complications in the 2D group (9.82%), and 7 complications in the 3D group (4.05%). Conclusions: It was found that 3D endoscopic surgeries significantly reduced the length of surgery, especially in serious bilateral paranasal sinus surgeries. and influenced a decrease in perioperative complications. 3D endoscopic surgeries had no significant effect on the amount of blood loss and the length of the patient’s stay at the Clinic.