Surgical Endoscopy

, Volume 24, Issue 5, pp 1132–1143 | Cite as

Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera

  • Seong-Ho Kong
  • Byung-Mo Oh
  • Hongman Yoon
  • Hye Seong Ahn
  • Hyuk-Joon Lee
  • Sun Geun Chung
  • Norio Shiraishi
  • Seigo Kitano
  • Han-Kwang YangEmail author



This study evaluated the effects of a three-dimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system.


In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles.


The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system.


The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery.


Imaging and virtual reality Surgical Training 



We thank the medical students, interns, and fellow surgeons who participated in this study. We also thank Tae Su Han, Jae Jin Cho, and Jee Eun Yoo for their contributions of time checking and EMG monitoring to this study.


Seong-Ho Kong, Byung-Mo Oh, Hongman Yoon, Hye Seong Ahn, Hyuk-Joon Lee, Sun Geun Chung, Norio Shiraishi, Seigo Kitano, and Han-Kwang Yang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Berguer R, Smith WD, Chung YH (2001) Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc 15:1204–1207CrossRefPubMedGoogle Scholar
  2. 2.
    Gofrit ON, Mikahail AA, Zorn KC, Zagaja GP, Steinberg GD, Shalhav AL (2008) Surgeons’ perceptions and injuries during and after urologic laparoscopic surgery. Urology 71:404–407CrossRefPubMedGoogle Scholar
  3. 3.
    Berguer R, Gerber S, Kilpatrick G, Remler M, Beckley D (1999) A comparison of forearm and thumb muscle electromyographic responses to the use of laparoscopic instruments with either a finger grasp or a palm grasp. Ergonomics 42:1634–1645CrossRefPubMedGoogle Scholar
  4. 4.
    Galleano R, Carter F, Brown S, Frank T, Cuschieri A (2006) Can armrests improve comfort and task performance in laparoscopic surgery? Ann Surg 243:329–333CrossRefPubMedGoogle Scholar
  5. 5.
    Jourdan IC, Dutson E, Garcia A, Vleugels T, Leroy J, Mutter D, Marescaux J (2004) Stereoscopic vision provides a significant advantage for precision robotic laparoscopy. Br J Surg 91:879–885CrossRefPubMedGoogle Scholar
  6. 6.
    Becker H, Melzer A, Schurr MO, Buess G (1993) 3-D video techniques in endoscopic surgery. Endosc Surg Allied Technol 1:40–46PubMedGoogle Scholar
  7. 7.
    van Bergen P, Kunert W, Bessell J, Buess GF (1998) Comparative study of two-dimensional and three-dimensional vision systems for minimally invasive surgery. Surg Endosc 12:948–954CrossRefPubMedGoogle Scholar
  8. 8.
    Birkett DH, Josephs LG, Este-McDonald J (1994) A new 3-D laparoscope in gastrointestinal surgery. Surg Endosc 8:1448–1451CrossRefPubMedGoogle Scholar
  9. 9.
    Taffinder N, Smith SG, Huber J, Russell RC, Darzi A (1999) The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons. Surg Endosc 13:1087–1092CrossRefPubMedGoogle Scholar
  10. 10.
    Tevaearai HT, Mueller XM, von Segesser LK (2000) 3-D vision improves performance in a pelvic trainer. Endoscopy 32:464–468CrossRefPubMedGoogle Scholar
  11. 11.
    Peitgen K, Walz MV, Holtmann G, Eigler FW (1996) A prospective randomized experimental evaluation of three-dimensional imaging in laparoscopy. Gastrointest Endosc 44:262–267CrossRefPubMedGoogle Scholar
  12. 12.
    Chan AC, Chung SC, Yim AP, Lau JY, Ng EK, Li AK (1997) Comparison of two-dimensional vs three-dimensional camera systems in laparoscopic surgery. Surg Endosc 11:438–440CrossRefPubMedGoogle Scholar
  13. 13.
    Hanna GB, Shimi SM, Cuschieri A (1998) Randomised study of influence of two-dimensional versus three-dimensional imaging on performance of laparoscopic cholecystectomy. Lancet 351:248–251CrossRefPubMedGoogle Scholar
  14. 14.
    Herron DM, Lantis JC II, Maykel J, Basu C, Schwaitzberg SD (1999) The 3-D monitor and head-mounted display: a quantitative evaluation of advanced laparoscopic viewing technologies. Surg Endosc 13:751–755CrossRefPubMedGoogle Scholar
  15. 15.
    McDougall EM, Soble JJ, Wolf JS Jr, Nakada SY, Elashry OM, Clayman RV (1996) Comparison of three-dimensional and two-dimensional laparoscopic video systems. J Endourol 10:371–374CrossRefPubMedGoogle Scholar
  16. 16.
    Mueller MD, Camartin C, Dreher E, Hanggi W (1999) Three-dimensional laparoscopy: gadget or progress? A randomized trial on the efficacy of three-dimensional laparoscopy. Surg Endosc 13:469–472CrossRefPubMedGoogle Scholar
  17. 17.
    Sun CC, Chiu AW, Chen KK, Chang LS (2000) Assessment of a three-dimensional operating system with skill tests in a pelvic trainer. Urol Int 64:154–158CrossRefPubMedGoogle Scholar
  18. 18.
    Byrn JC, Schluender S, Divino CM, Conrad J, Gurland B, Shlasko E, Szold A (2007) Three-dimensional imaging improves surgical performance for both novice and experienced operators using the da Vinci Robot System. Am J Surg 193:519–522CrossRefPubMedGoogle Scholar
  19. 19.
    Votanopoulos K, Brunicardi FC, Thornby J, Bellows CF (2008) Impact of three-dimensional vision in laparoscopic training. World J Surg 32:110–118CrossRefPubMedGoogle Scholar
  20. 20.
    Patel HR, Ribal MJ, Arya M, Nauth-Misir R, Joseph JV (2007) Is it worth revisiting laparoscopic three-dimensional visualization? A validated assessment. Urology 70:47–49CrossRefPubMedGoogle Scholar
  21. 21.
    Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR (2002) Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 60:39–45 discussion 45CrossRefPubMedGoogle Scholar
  22. 22.
    Guru KA, Kuvshinoff BW, Pavlov-Shapiro S, Bienko MB, Aftab MN, Brady WE, Mohler JL (2007) Impact of robotics and laparoscopy on surgical skills: a comparative study. J Am Coll Surg 204:96–101CrossRefPubMedGoogle Scholar
  23. 23.
    Vlaovic PD, Sargent ER, Boker JR, Corica FA, Chou DS, Abdelshehid CS, White SM, Sala LG, Chu F, Le T, Clayman RV, McDougall EM (2008) Immediate impact of an intensive one-week laparoscopy training program on laparoscopic skills among postgraduate urologists. JSLS 12:1–8PubMedGoogle Scholar
  24. 24.
    Tendick F, Bhoyrul S, Way LW (1997) Comparison of laparoscopic imaging systems and conditions using a knot-tying task. Comput Aided Surg 2:24–33CrossRefPubMedGoogle Scholar
  25. 25.
    Perotto A (1994) Anatomical guide for the electromyographer, the limbs and trunk, 3rd edn. Thomas, SpringfieldGoogle Scholar
  26. 26.
    Fishman JM, Ellis SR, Hasser CJ, Stern JD (2008) Effect of reduced stereoscopic camera separation on ring placement with a surgical telerobot. Surg Endosc 22:2396–2400CrossRefPubMedGoogle Scholar
  27. 27.
    Hanna GB, Cuschieri A (2000) Influence of two-dimensional and three-dimensional imaging on endoscopic bowel suturing. World J Surg 24:444–448 discussion 448–449CrossRefPubMedGoogle Scholar
  28. 28.
    Voorhorst FA, Overbeeke KJ, Smets GJ (1996) Using movement parallax for 3D laparoscopy. Med Prog Technol 21:211–218CrossRefPubMedGoogle Scholar
  29. 29.
    Gallagher AG, Cowie R, Crothers I, Jordan-Black JA, Satava RM (2003) PicSOr: an objective test of perceptual skill that predicts laparoscopic technical skill in three initial studies of laparoscopic performance. Surg Endosc 17:1468–1471CrossRefPubMedGoogle Scholar
  30. 30.
    Hagiike M, Phillips EH, Berci G (2007) Performance differences in laparoscopic surgical skills between true high-definition and three-chip CCD video systems. Surg Endosc 21:1849–1854CrossRefPubMedGoogle Scholar
  31. 31.
    Blehm C, Vishnu S, Khattak A, Mitra S, Yee RW (2005) Computer vision syndrome: a review. Surv Ophthalmol 50:253–262CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Seong-Ho Kong
    • 1
  • Byung-Mo Oh
    • 2
  • Hongman Yoon
    • 1
  • Hye Seong Ahn
    • 1
  • Hyuk-Joon Lee
    • 1
  • Sun Geun Chung
    • 2
  • Norio Shiraishi
    • 3
  • Seigo Kitano
    • 3
  • Han-Kwang Yang
    • 1
    Email author
  1. 1.Department of SurgerySeoul National University College of MedicineSeoulKorea
  2. 2.Department of Rehabilitation MedicineSeoul National University College of MedicineSeoulKorea
  3. 3.Department of Surgery I, Faculty of MedicineOita UniversityOitaJapan

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