title: The viewpoint-specific failure of modern 3D displays in laparoscopic surgery.
abstract: OBJECTIVE
  Surgeons conventionally assume the optimal viewing position during 3D laparoscopic surgery and may not be aware of the potential hazards to team members positioned across different suboptimal viewing positions. The first aim of this study was to map the viewing positions within a standard operating theatre where individuals may experience visual ghosting (i.e. double vision images) from crosstalk. The second aim was to characterize the standard viewing positions adopted by instrument nurses and surgical assistants during laparoscopic pelvic surgery and report the associated levels of visual ghosting and discomfort.
  
  
  METHODS
  In experiment 1, 15 participants viewed a laparoscopic 3D display from 176 different viewing positions around the screen. In experiment 2, 12 participants (randomly assigned to four clinically relevant viewing positions) viewed laparoscopic suturing in a simulation laboratory. In both experiments, we measured the intensity of visual ghosting. In experiment 2, participants also completed the Simulator Sickness Questionnaire.
  
  
  RESULTS
  We mapped locations within the dimensions of a standard operating theatre at which visual ghosting may result during 3D laparoscopy. Head height relative to the bottom of the image and large horizontal eccentricities away from the surface normal were important contributors to high levels of visual ghosting. Conventional viewing positions adopted by instrument nurses yielded high levels of visual ghosting and severe discomfort.
  
  
  CONCLUSIONS
  The conventional viewing positions adopted by surgical team members during laparoscopic pelvic operations are suboptimal for viewing 3D laparoscopic displays, and even short periods of viewing can yield high levels of discomfort.
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. shin.sakata@gmail.com.|Clinical Skills Development Service, Queensland Health, Herston, Brisbane, Queensland, Australia. shin.sakata@gmail.com.|Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. shin.sakata@gmail.com.
authors.forename: Shinichiro
authors.identifier: http://orcid.org/0000-0002-9085-6755
authors.initials: S
authors.lastname: Sakata
authors.affiliation: School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Grove
authors.affiliation: Clinical Skills Development Service, Queensland Health, Herston, Brisbane, Queensland, Australia.|School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Clinical Skills Development Service, Queensland Health, Herston, Brisbane, Queensland, Australia.|School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Marcus O
authors.initials: MO
authors.lastname: Watson
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Andrew R L
authors.initials: AR
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration; D011187:Posture; D025321:Surgery, Computer-Assisted
keywords: 3D; Crosstalk; Laparoscopic ventral rectopexy; Laparoscopy; Simulator Sickness Questionnaire