title: Effect of passive polarizing three-dimensional displays on surgical performance for experienced laparoscopic surgeons.
abstract: BACKGROUND
  Although the potential benefits of stereoscopic laparoscopy have been recognized for years, the technology has not been adopted because of poor operator tolerance. Passive polarizing projection systems, which have revolutionized three-dimensional (3D) cinema, are now being trialled in surgery. This study was designed to see whether this technology resulted in significant performance benefits for skilled laparoscopists.
  
  
  METHODS
  Four validated laparoscopic skills tasks, each with ten repetitions, were performed by 20 experienced laparoscopic surgeons, in both two-dimensional (2D) and 3D conditions. The primary outcome measure was the performance error rate; secondary outcome measures were time for task completion, 3D motion tracking (path length, motion smoothness and grasping frequency) and workload dimension ratings of the National Aeronautics and Space Administration (NASA) Task Load Index.
  
  
  RESULTS
  Surgeons demonstrated a 62 per cent reduction in the median number of errors and a 35 per cent reduction in median performance time when using the passive polarizing 3D display compared with the 2D display. There was a significant 15 per cent reduction in median instrument path length, an enhancement of median motion smoothness, and a 15 per cent decrease in grasper frequency with the 3D display. Participants reported significant reductions in subjective workload dimension ratings of the NASA Task Load Index following use of the 3D displays.
  
  
  CONCLUSIONS
  Passive polarizing 3D displays improved both the performance of experienced surgeons in a simulated setting and surgeon perception of the operative field. Although it has been argued that the experience of skilled laparoscopic surgeons compensates fully for the loss of stereopsis, this study indicates that this is not the case. Surgical relevance The potential benefits of stereoscopic laparoscopy have been known for years, but the technology has not been adopted because of poor operator tolerance. The first laparoscopic operation was carried out using a prototype passive polarizing laparoscopic system in 2010. This is new three-dimensional (3D) technology offers a real option for 3D laparoscopic surgery where previous systems have failed. This study is the first to have been carried out using this technology. It is essential that new technologies are adopted only when there is robust evidence to support their use. Currently, there are concerns about the use of robotic technologies and whether advantages exist for patient care. If there are advantages, 3D must be playing a significant role. If so, perhaps the technology under investigation here offers potential to a greater spectrum of surgeons, as well as being a more affordable option.
authors.affiliation: Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Smith
authors.forename: K
authors.initials: K
authors.lastname: Schwab
authors.forename: A
authors.initials: A
authors.lastname: Day
authors.forename: T
authors.initials: T
authors.lastname: Rockall
authors.forename: K
authors.initials: K
authors.lastname: Ballard
authors.forename: M
authors.initials: M
authors.lastname: Bailey
authors.forename: I
authors.initials: I
authors.lastname: Jourdan
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000592:standards*; D059032:Learning Curve; D008027:Light; D019300:Medical Errors / Q000706:statistics & numerical data; D011597:Psychomotor Performance / Q000502:physiology; D066231:Surgeons / Q000592:standards*; D016526:Workload