title: Three-Dimensional Versus Two-Dimensional Imaging in Adult Versus Pediatric Laparoscopy: A Simulator Box Study.
abstract: OBJECTIVE
  Three-dimensional (3D) imaging has been shown to enhance depth perception and facilitate operations in training box studies and in adult laparoscopy. However, there are no data on 3D vision in small working spaces, which are common pediatric surgery. Therefore, this study examined the impact of monoscopic versus stereoscopic visualization in large versus small working spaces in individuals with varying surgical expertise.
  
  
  METHODS
  Twenty-four individuals with varying surgical expertise (experts, surgical residents, and surgical novices) were involved in the study. Participants were asked to perform four tasks in large (24- × 30- × 50-cm) and small (9- × 11- × 18-cm) training boxes, using two-dimensional and 3D imaging. Sixteen standardized procedures were performed by each participant. Primary outcome measure was performance time. Secondary outcome parameters included the number of errors and subjective depth perception.
  
  
  RESULTS
  Surgical novices showed a shorter performance time and lesser total number of errors in large and small training boxes using 3D imaging. Residents achieved a significantly shorter performance time in the large and lesser number of errors in the small box. With 3D vision experts performed laparoscopic suturing in the small box and target touching in both boxes significantly faster. The overall performance time and total number of errors of experts were not different in the two boxes. Subjective depth perception with 3D vision in the small box in all groups and in the small box in surgical novices was significantly better.
  
  
  CONCLUSIONS
  We identified several advantages of 3D vision in individuals with varying surgical expertise. However, the benefits were rather experienced by surgical novices and residents than by experts. Differences in performance time and number of errors were similar in the large and small simulator boxes.
authors.affiliation: 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany .
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Feng
authors.affiliation: 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany .
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.affiliation: 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany .
authors.forename: Tawan
authors.initials: T
authors.lastname: Imvised
authors.affiliation: 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany .
authors.forename: Benno
authors.initials: B
authors.lastname: Ure
authors.affiliation: 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany .
authors.forename: Joachim F
authors.initials: JF
authors.lastname: Kuebler
authors.affiliation: 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany .|2 Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany .
authors.forename: Martin
authors.initials: M
authors.lastname: Lacher
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003867:Depth Perception; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D000066908:Simulation Training