Evaluation of face-mounted binocular video display for laparoscopy: Outcomes of psychometric skills testing and surgeon satisfaction

Objectives: Improved digital video cameras and high-resolution video displays have greatly enhanced laparoscopic surgery. However, the size and distance of the video display and the location of the monitor continue to be impediments in laparoscopy, providing unsatisfactory operative visualization and causing the development of neck and back strain in surgeons performing long procedures. The purpose of this study was to evaluate the use of a face-mounted binocular high-resolution video display by means of standardized measurements of laparoscopic skill, and to compare procedure speed and surgeon satisfaction with the binocular display, open operative visualization, and standard laparoscopic monitor views. Methods: The surgical faculty and resident trainees (n = 22) underwent two standardized laparoscopic psychometric skills tests of fine motor control and bimanual operative facility. Testing was performed first with the use of laparoscopic instruments in direct view of the participants; sufficient repetitions were allowed so that plateau levels were obtained in task speed. Video camera-based imaging displayed on the face-mounted binocular video display and a standard video monitor were then used to repeat identical tests. Test times were compared between the open view, face-mounted display (FMD) view, and standard laparoscopic monitor view groups. A Likert-scale based assessment was conducted to examine operator impressions of neck and back strain, visual acuity, and overall satisfaction. Results: Performance with the standard laparoscopic monitor was significantly slower than with the direct view on both fine motor (mean, 85.0 +/- 7.1 s vs. 56.4 +/- 5.7 s; P < .0001) and bimanual (mean, 80.8 +/- 7.0 s vs. 40.2 +/- 2.6 s; P = .009) psychometric skills tests. The FMD view performance was significantly faster than the standard laparoscopic monitor performance for both the bimanual (mean, 72.2 +/- 7.6 s vs. 85.0 +/- 7.2 s; P = .001) and fine motor (mean, 59.3 +/- 4.7 s vs. 80.8 +/- 7.0 s; P = .004) tests. The scores on a Likert Scale satisfaction survey of the use of the FMD unit for neck and back strain (mean, 4.27 +/- 0.20), visual acuity (mean, 3.93 +/- 0.10), and overall satisfaction (mean, 4.16 +/- 0.20) were high (scale: 1, worst; 5, ideal). Conclusions: A face-mounted high-resolution video display unit reduces neck and back strain and improves both visualization and overall satisfaction in comparison with standard laparoscopic display monitors; surgical performance is better than with standard laparoscopic imaging as assessed by standardized psychometric skills testing.