In the present era of technology revolt better innovations are rapidly growing to bridge the demands created by the older types of equipment, and this also changes the conventional methods of practising. Our study compared the traditional optical microscope with modern Ngenuity 3D visualization in VR surgeries. We highlighted the surgeon’s preference between the two, advantages, and difficulties faced in each step of the procedure. Ngenuity 3D Visualization System was developed in collaboration with True Vision, it provides a unique integrated 3D, high-definition approach for digitally assisted vitreoretinal surgery . It mainly concentrates over the ergonomic aspects, superior depth perception, stereopsis, adaptive illumination, and digital image amplification (1–3).
On comparing the ergonomic parameters Ngenuity provided better upper and lower body comfort, and educational value over the microscope, the surgeons were able to make a better neck and body movements to the extent which facilized upper body comfort. Improved depth perceptions, field of view and resolution added on to the comfort, but the estimated time lag was more for anterior segment procedures than posterior segment steps. The mean score was > 7 for educational value and upper body comfort. Parameters like depth perception and time lag had a mean score of < 6. Similarly, In a recent study Ngenuity and microscope was compared for macular hole surgery in 50 eyes, they reported that comfort and the educational value was improved with Ngenuity, and the visual acuity, total surgery time, internal limiting membrane peel time (ILM), number of flap initiations and macular hole closure was same between the two systems . Another study reported that the 3D system had 80 milliseconds of time lag than standard microscope during vitrectomy plus endolaser and gas or silicone oil for retinal detachment repair .
Some studies have reported discomforts such as headache nausea and visual disturbances with Ngenuity. These symptoms are assumed to be associated with constant flickering light which is a disruptive visual stimulation that affects vestibular and proprioceptive systems , but such symptoms and side effects were not reported by the surgeons in our study. In our study majority of surgeons felt that the field of view was bigger with Ngenuity than the microscope. Similarly, a recent study stated that three fourth of the surgeons (N = 23) felt DAVS provided a wider field of view . The depth of field, resolution, zooming, focusing, speed and ease of operation was observed to be similar between the analogue microscope and digitally assisted vitreoretinal surgery systems (DAVS) . DAVS provides higher resolution than analogue microscope at all magnifications and better depth of field only with 5x magnification, 13x and 18x was found to be similar with both the systems .
We compared the surgeon’s preference for each step during the surgery for 31 eyes, the microscope was preferred for the scleral tunnel for buckle and Conjunctival opening. Ngenuity was preferred for truncation of the cone, PVD induction, Endo laser, Fluid gas exchange and tamponade injection. IOL related steps like the scleral tunnel, IOL placement and IOL dialling surgeons preferred microscope more than the Ngenuity. Steps like scleral IOL fixation, tamponade injection, posterior vitreous detachment induction had mean grading score of > 4 (on a scale of 1–5). While conjunctival suturing, external subretinal fluid drainage, suture placement for the buckle and the conjunctival opening had meaning grading score of < 3. This difference in the preference may be due to the image latency period that had a more definite effect in the anterior procedures. This preference between the steps might change over the learning curve and many studies emphasize that surgeons felt more comfortable with Ngenuity in both anterior and posterior procedures after 3 or 4 surgeries which was considered to a short period [7, 8].
The identified downsides in our study were, parameters like discomforts like asthenopia symptoms were not looked onto. Direct comparison between Ngenuity and traditional microscope was not made, which will give a better comprehension about this comparison. The learning curve period of the surgeons to perform the procedures comfortably was not reported. Adding these points to future studies would establish a better understanding of the surgeon’s needs and satisfaction with Ngenuity. The identified drawbacks of the 3D system from our study were, it’s a high-cost technology, time lag was reported by most of the surgeons and performing anterior segment procedures was uncomfortable.