title: The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons.
abstract: BACKGROUND
  Endoscopic surgeons rely on visual feedback to control their movements but lack stereopsis, an important depth cue. Previous three-dimensional (3D) systems alternated images on a two-dimensional (2D) screen, which was uncomfortable for surgeons. A second-generation 3D system provides continuous stereoscopic images on a monitor suspended at arm's length. We studied its effect on the laparoscopic precision of novices and experienced surgeons.
  
  
  METHODS
  Experienced laparoscopic surgeons (n = 12) and novices (n = 16) performed a total of 672 tasks in 2D, 3D, and under direct vision. Precision was assessed using the Imperial College Surgical Assessment Device (ICSAD), which generates objective scores of performance by analyzing the movements of surgical instruments.
  
  
  RESULTS
  We found that 2D endoscopic vision impaired performance by 35-100% when compared with direct vision, whereas 3D reduced this endoscopic handicap by 41-53% in novices and experienced surgeons (p < 0.03). No side effects were reported with the new 3D system. Even in 2D, novices performed better with an image at arm's length (p < 0. 03).
  
  
  CONCLUSIONS
  Second-generation 3D significantly improved the laparoscopic precision of novices and experienced surgeons, without the side effects reported from previous systems. This technology is expected to improve the ease and safety of laparoscopic surgery.
authors.affiliation: Minimal Access Surgical Unit, Imperial College School of Medicine at St. Mary's, Praed Street, London W2 1NY, UK.
authors.forename: N
authors.initials: N
authors.lastname: Taffinder
authors.forename: S G
authors.initials: SG
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Huber
authors.forename: R C
authors.initials: RC
authors.lastname: Russell
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D004867:Equipment Design; D013502:General Surgery; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D013337:Students, Medical