Head Mounted Three-Dimensional High-Definition Display System for Microscopic Surgical Field Observation: An Observational Study.

Objective: Microscopic surgery poses ergonomic challenges due to the constraints of fixed eyepieces. While monitor-based exoscopes offer alternatives, they may limit immersion and assistant visibility. Head-mounted displays (HMDs) have proposed these constraints. This study evaluated the technical capabilities of a three-dimensional high-definition HMD system during surgical simulation to determine its usability compared with conventional and exoscopic visualization methods.

Methods: Thirty-five physicians and residents with varying microsurgical experience evaluated 3 visualization methods: HMD, conventional microscope eyepieces, and a 55″ exoscopic monitor. The evaluation criteria included resolution, immersion, depth perception, ergonomic comfort, peripheral vision, and visual latency. We also measured the effective latency times.

Results: HMD ranked between the microscope and exoscope across all evaluation criteria. The microscope was rated highest in resolution, immersion, depth perception, and visual latency. Surgeons with >5 years of practice rated HMD higher than microscopes for ergonomics (P = 0.029) and peripheral vision (P = 0.009). The measured image latency was approximately 0.093 ± 0.0018 s. Finally, the HMD system showed better operator and assistant participation.

Conclusions: While the HMD showed potential for ergonomic benefit and enhanced peripheral engagement, further development is needed, particularly regarding image quality, and magnification. Given that clinical integration in this preliminary study was limited to observation; further development is needed, including larger numbers of cases and diverse operative settings, including primary surgeons, assistants, scrub nurses, and surgical observers.