Purpose:
　　The 3D virtual image system is prevailing at current modern surgeries. With improvements in computational power and advances in visual and haptic display technologies, virtual surgical environments can now offer potential benefits for surgical training, planning, and rehearsal in a safe, simulated setting. It is readily compensated by provide depth perception and stereotactic visualization to the operator. Even though the innovative development, the surgeon still needs to overcome the learning cascade. We reviewed our cases applying two different technologies.
Materials and Methods:
　　Between 2015 and 2016, 20 patients were selected and underwent endoscopic endonasal skull base surgeries (EESBS). We performed EESBS either by aids of virtual 3D conversion simulator (SHINKO, Tokyo, Japan) or head-mounted display (HMD, SONY-HMZ, Tokyo, Japan) visulization. The peri-operative maneuverability (score 0-4) was compared to the other standard EESBS purely by full-HD system. The operator’s discomfort (cybersickness) in this adaptation to the new approach was also analyzed. The flow of procedure and complications were recorded at outpatient follow-up.
Results:
　　All patients experienced neurologic improvement after the operations. Nine patients had no recurrence and hormonal balance at serial follow-up, only one patient underwent stereotactic radiosurgery on account of residual tumor. There was no catastrophic vascular conflict and major complications (CSF leaks, bacterial meningitis…etc) in our cohort. The mean operation time and maneuverability were comparable with our controlled full-HD group (p=0.01). With regard to the wearing limitation, repeated training can vanish the cybersickness and it is associated with the individual tolerance.
Conclusions:
　　The use of the virtual 3D integrated technology showed the comparative effectiveness for EESBS. We believed there is promising potential to mature this novel technology.