Thematic analysis
Seven over-arching themes were identified from the data and categorized into advantages or disadvantages of the 3D endoscopy system, or additional themes, as described in Table 1. The identified themes are discussed in more detail as follows.
Improved stereoscopic vision when using 3D endoscopy was a recurring point of discussion for all six participants.
“When using a 2D scope, [surgeons] have learned to simulate depth perception by moving the endoscope frequently to generate a 3D map in their mind. With the 3D endoscope, you have 3D perception immediately and you appreciate the relationship of different structures in different dimensions very quickly.” (Participant #1)
“You gain the feeling of moving through space to better appreciate the anatomy rather than just looking at the anatomy.” (Participant #4)
This improved visualization had clinical applicability to better discriminate laryngeal anatomy, thus facilitating laryngeal surgery. This was identified by four of the six participants.
“The main benefit [of 3D endoscopy] is ability for more precision due to the depth perception. This was particularly noticeable for laryngeal papillomatosis, where a fraction of a millimeter counts to get rid of disease and retain the normal structure.” (Participant #5)
Moreover, 3D endoscopy was found to be a valuable teaching tool due the more detailed visualization of anatomical structures.
“In surgical training, [3D endoscopy] gives you a better perspective to advise trainees on how to improve their technique, but also to recognize that techniques are being done safely and appropriately. I feel more confident that I can see exactly what they are doing.” (Participant #1)
This teaching benefit of 3D endoscopy was pervasive in all interviews.
“When there is an opportunity to teach, I would like to use [3D endoscopy] in almost every case.” (Participant #6)
In contrast, all participants found 3D endoscopy to require additional set-up time and careful equipment positioning; however, the surgeons found that this resolved with increased device use and familiarity.
“The [support] staff must know what they are doing during set-up…there are no problems with the equipment itself.” (Participant #3)
Two participants found impaired utility of 3D endoscopy compared to other surgical techniques in clinical scenarios when the width of the instrument did not allow for access to the surgical site.
“In the smallest babies, the scope is likely too big.” (Participant #3)
DISCUSSION
Our qualitative investigation of pediatric Otolaryngologist experience in 3D endoscopic surgery found this innovative technology to improve visualization thereby facilitating surgical and anatomical teaching. Moreover, 3D endoscopic technology was found to be particularly effective in laryngeal surgery, although the endoscope’s width can limit its utility in certain clinical scenarios.