title: Performance differences in laparoscopic surgical skills between true high-definition and three-chip CCD video systems.
abstract: BACKGROUND
  Laparoscopic surgery requires surgeons to rely on visual clues for discrimination among differing tissues and for depth of field on a two-dimensional screen. High definition (HD) provides a superior image. If there is a measurable advantage with HD television (TV), the increase in the cost of the technology would be justified.
  
  
  METHODS
  A digital three-chip CCD camera with a standard monitor (SD system) and a true HD camera (1,080 pixels) with a 16:9-ratio HD monitor (HD system) were compared in clinical and laboratory settings. Three experiments were performed: (1) subjective visual evaluation of the HD and SD systems during actual surgical cases, (2) subjective visual evaluation in a controlled laboratory surgical setting with simultaneous parallel recording, and (3) three laparoscopic surgical task evaluations in a laboratory setting, namely, task A (metric analysis of participants on the surgical simulator), task B (simple eye-hand coordination performance), and task C (knot tying).
  
  
  RESULTS
  All 53 participants subjectively evaluated HD as superior to SD in the laboratory setting and during actual surgery. In task B, there was no significant difference between SD and HD (dominant hand: p = 0.19; nondominant hand: p = 0.07). In task C, the knot-tying time was significantly less when performed with HD (mean, 173 +/- 84 s vs 214 +/- 107 s; p = 0.003). Most importantly, subjects with less skill (more documented time required in the basic module on a surgical simulator) improved significantly in the knot-tying task with the HD system (R = 0.631; p = 0.005).
  
  
  CONCLUSIONS
  All the participants preferred HD to SD. High definition significantly improved laparoscopic knot tying, which requires precise depth perception, proving that HD is more than just a pretty picture.
authors: Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 795 W, Los Angeles, CA 90048, USA.
authors: M
authors: M
authors: Hagiike
authors: E H
authors: EH
authors: Phillips
authors: G
authors: G
authors: Berci
mesh_terms: D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D014741:Video Recording
references: Arch Surg. 1996 Apr;131(4):396-401
references: 8615725
references: J Med Eng Technol. 2005 Sep-Oct;29(5):244-50
references: 16126586
references: Surg Endosc. 2000 Jan;14(1):71-4
references: 10653241
references: Surg Endosc. 2005 May;19(5):730-3
references: 15759191
references: Ann Otol Rhinol Laryngol. 2006 Feb;115(2):110-3
references: 16514792
references: Surg Endosc. 1995 Sep;9(9):967-73
references: 7482214
references: Rev Urol. 2005 Fall;7(4):211-4
references: 16985832
references: Surg Endosc. 2007 Dec;21(12):2253-7
references: 17479319
references: Surg Endosc. 2001 Nov;15(11):1282-8
references: 11727134