The influence of three-dimensional video systems on laparoscopic task performance

Many laparoscopic surgeons feel constrained by the two-dimensional (2-D) view provided by video monitors. Video-eye-hand coordination is further complicated by the diminished tactile feedback blunted by elongated instruments. Video systems capable of receiving and displaying three-dimensional (3-D) images are now available for laparoscopy. First-generation 3-D systems have been marketed with the promise of significant time savings in laparoscopic procedures compared with 2-D optics. We assessed whether laparoscopic task performance was better in 2-D or 3-D among individuals with varying levels of laparoscopic experience. Five different tasks were performed in random order using both 2-D and 3-D technology by medical students (n = 10), inexperienced surgical residents (n = 10), and laparoscopic attending surgeons (n = 10). There was no significant difference in task performance between 2-D and 3-D among groups performing simple or difficult tasks, although suturing and knot-tying were performed 12% (p = 0.06) faster in 3-D by all groups. With repetition of tasks three times, the difference between the 2-D and 3-D systems was indistinguishable. Subjective assessment of the video systems by participants revealed that only 46% (p = 0.72) preferred working in three dimensions, despite 60% (p = 0.27) sensing more motor control in 3-D. Our results suggest that first-generation 3-D video systems offer no significant advantage to the novice or expert surgeon performing laparoscopic procedures. Further trials with the next generation of 3-D video systems and a larger sample size may support the trend favoring 3-D for more complex maneuvers, such as suturing and knot-typing.