ArticleNeuroSci2026
Reconstructed Three-Dimensional vs. Two-Dimensional Visualization in Unilateral Biportal Endoscopic Spine Surgery: A Randomized Crossover Simulation Feasibility Study.
Article in NeuroSci, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
BACKGROUND/
objectivesReconstructed three-dimensional (3D) endoscopic visualization is believed to improve depth perception and surgical performance compared with conventional two-dimensional (2D) systems. However, evidence supporting its use in unilateral biportal endoscopic (UBE) spine surgery remains limited. The objective was to compare procedural performance, task completion times, and subjective workload between 3D and 2D visualization in simulated biportal lumbar endoscopy.
methodsThis randomized crossover pilot feasibility ex vivo study enrolled 6 neurosurgeons (3 residents, 3 seniors) who each completed a standardized UBE lumbar discectomy simulation (UpSurgeOn Lumbar SpineBox) under both 3D and 2D visualization in randomized sequence. The primary outcome was composite procedural performance (0-100 scale) assessed using a multi-item checklist encompassing technical success, quality, and safety. Secondary outcomes included task completion times for 7 procedural steps and subjective workload. Linear mixed-effects models adjusted for expertise level, spinal segment, operative side, and session order. Within-participant effect sizes (Cohen's d) and a sensitivity power analysis were calculated.
resultsAll participants completed both conditions (24 procedures). Composite performance was high with both modalities, with no significant difference for the unweighted (adjusted difference 0.64 points, 95% CI -3.67 to 4.96,
conclusions3D visualization was feasible and well tolerated but did not significantly improve procedural performance, task completion time, or subjective workload in UBE simulation. Because the study was powered to detect only very large effects, these nonsignificant results reflect limited power rather than equivalence, and the medium effect-size signals for fatigue and situational stress are hypothesis-generating. Adequately powered trials are needed to confirm task-specific or expertise-dependent benefits.
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