Evaluation of the impact of three-dimensional vision on laparoscopic performance.
BACKGROUND
Recent technological advancements have led to the introduction of new three-dimensional (3D) cameras in laparoscopic surgery. The 3D view has been touted as useful during robotic surgery, however, there has been limited investigation into the utility of 3D in laparoscopy.


METHODS
We performed a prospective, randomized crossover trial comparing a 0° 3D camera with a conventional 0° two-dimensional (2D) camera using a high definition monitor (Karl Storz, Tuttlingen, Germany). All participants completed six standardized basic skills tasks. Quality testing scores were measured by the number of drops, grasping attempts, and precision of needle entry and exiting. Additionally, resolution, color distribution, depth of field and distortion were measured using optical test targets.


RESULTS
In this pilot study, we evaluated 10 medical students, 7 residents, and 7 expert surgeons. There was a significant difference in the performance in all the six skill tasks, for the three levels of surgical expertise and training levels in 2D vs 3D except for the cut the line quality score and the peg transfer quality score. Adjusting for the training level, 3D camera image results were superior for the number of rings left (p=0.041), ring transfer quality score (p=0.046), thread the rings (no. of rings) (p=0.0004), and thread the rings quality score (p=0.0002). The 3D camera image was also superior for knot tying (quality score) (p=0.004), peg transfer (time in seconds) (p=0.047), peg transfer pegs left (p=0.012), and for peg transfer quality score (p=0.001). The 3D camera system showed significantly less distortion (p=0.0008), a higher depth of field (p=0.0004) compared with the 2D camera system.


CONCLUSIONS
3D laparoscopic camera equipment results in a significant improvement in depth perception, spatial location, and precision of surgical performance compared with the conventional 2D camera equipment. With this improved quality of vision, even expert laparoscopic surgeons may benefit from 3D imaging.
Department of Urology, University of California , Irvine, Orange, California.
Achim
A
Lusch
Philip L
PL
Bucur
Ashleigh D
AD
Menhadji
Zhamshid
Z
Okhunov
Michael Andre
MA
Liss
Alberto
A
Perez-Lanzac
Elspeth M
EM
McDougall
Jaime
J
Landman
D002983:Clinical Competence; D018592:Cross-Over Studies; D003867:Depth Perception; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D007396:Internship and Residency; D010535:Laparoscopy / Q000592:standards*; D010865:Pilot Projects; D011446:Prospective Studies; D012371:Robotics; D013647:Task Performance and Analysis; D014785:Vision, Ocular