Surgical Endoscopy

, Volume 28, Issue 8, pp 2387–2397 | Cite as

Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D

  • D. Wilhelm
  • S. Reiser
  • N. Kohn
  • M. Witte
  • U. Leiner
  • L. Mühlbach
  • D. Ruschin
  • W. Reiner
  • H. Feussner
Article

Abstract

Background

Though theoretically superior to standard 2D visualization, 3D video systems have not yet achieved a breakthrough in laparoscopy. The latest 3D monitors, including autostereoscopic displays and high-definition (HD) resolution, are designed to overcome the existing limitations.

Methods

We performed a randomized study on 48 individuals with different experience levels in laparoscopy. Three different 3D displays (glasses-based 3D monitor, autostereoscopic display, and a mirror-based theoretically ideal 3D display) were compared to a 2D HD display by assessing multiple performance and mental workload parameters and rating the subjects during a laparoscopic suturing task. Electromagnetic tracking provided information on the instruments’ pathlength, movement velocity, and economy. The usability, the perception of visual discomfort, and the quality of image transmission of each monitor were subjectively rated.

Results

Almost all performance parameters were superior with the conventional glasses-based 3D display compared to the 2D display and the autostereoscopic display, but were often significantly exceeded by the mirror-based 3D display. Subjects performed a task faster and with greater precision when visualization was achieved with the 3D and the mirror-based display. Instrument pathlength was shortened by improved depth perception. Workload parameters (NASA TLX) did not show significant differences. Test persons complained of impaired vision while using the autostereoscopic monitor. The 3D and 2D displays were rated user-friendly and applicable in daily work. Experienced and inexperienced laparoscopists profited equally from using a 3D display, with an improvement in task performance about 20 %.

Conclusion

Novel 3D displays improve laparoscopic interventions as a result of faster performance and higher precision without causing a higher mental workload. Therefore, they have the potential to significantly impact the further development of minimally invasive surgery. However, as shown by the custom-built 3D mirror display, this effect can be improved, thus stimulating further research.

Keywords

Imaging Laparoscopic monitors Training courses 

References

  1. 1.
    Hubber JW, Taffinder N, Russell RC, Darzi A (2003) The effects of different viewing conditions on performance in simulated minimal access surgery. Ergonomics 46(10):999–1016PubMedCrossRefGoogle Scholar
  2. 2.
    Kunert W, Storz P, Muller S, Axt S, Kirschniak A (2013) [3D in laparoscopy: state of the art]. Chirurg 84(3):202–207 Google Scholar
  3. 3.
    Buess GF, van Bergen P, Kunert W, Schurr MO (1996) Comparative study of various 2-D and 3-D vision systems in minimally invasive surgery. Chirurg 67(10):1041–1046PubMedCrossRefGoogle Scholar
  4. 4.
    Dion YM, Gaillard F (1997) Visual integration of data and basic motor skills under laparoscopy. Influence of 2-D and 3-D video-camera systems. Surg Endosc 11(10):995–1000PubMedCrossRefGoogle Scholar
  5. 5.
    Pietrabissa A, Scarcello E, Carobbi A, Mosca F (1994) Three-dimensional versus two-dimensional video system for the trained endoscopic surgeon and the beginner. Endosc Surg Allied Technol 2(6):315–317PubMedGoogle Scholar
  6. 6.
    Feng C, Rozenblit JW, Hamilton AJ (2010) A computerized assessment to compare the impact of standard, stereoscopic, and high-definition laparoscopic monitor displays on surgical technique. Surg Endosc 24(11):2743–2748PubMedCrossRefGoogle Scholar
  7. 7.
    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(7):879–885PubMedCrossRefGoogle Scholar
  8. 8.
    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(11):1087–1092PubMedCrossRefGoogle Scholar
  9. 9.
    van Bergen P, Kunert W, Buess GF (1999) Three-dimensional (3-D) video systems: bi-channel or single-channel optics? Endoscopy 31(9):732–737PubMedCrossRefGoogle Scholar
  10. 10.
    Kong SH, Oh BM, Yoon H, Ahn HS, Lee HJ, Chung SG, Shiraishi N, Kitano S, Yang HK (2010) Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera. Surg Endosc 24(5):1132–1143PubMedCrossRefGoogle Scholar
  11. 11.
    Hofmeister J, Frank TG, Cuschieri A, Wade NJ (2001) Perceptual aspects of two-dimensional and stereoscopic display techniques in endoscopic surgery: review and current problems. Semin Laparosc Surg 8(1):12–24PubMedCrossRefGoogle Scholar
  12. 12.
    McLachlan G (2011) From 2D to 3D: the future of surgery? Lancet 378(9800):1368PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen J (1977) Statistical power analysis for the behavioral sciences. Academic Press, LondonGoogle Scholar
  14. 14.
    Mather G, Smith DR (2004) Combining depth cues: effects upon accuracy and speed of performance in a depth-ordering task. Vision Res 44(6):557–562PubMedCrossRefGoogle Scholar
  15. 15.
    Schulz CM, Skrzypczak M, Schneider E, Hapfelmeier A, Martin J, Kochs EF, Schneider G (2011) Assessment of subjective workload in an anaesthesia simulator environment: reliability and validity. Eur J Anaesthesiol 28(7):502–505PubMedCrossRefGoogle Scholar
  16. 16.
    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(10):1849–1854PubMedCrossRefGoogle Scholar
  17. 17.
    van Bergen P, Kunert W, Buess GF (2000) The effect of high-definition imaging on surgical task efficiency in minimally invasive surgery: an experimental comparison between three-dimensional imaging and direct vision through a stereoscopic TEM rectoscope. Surg Endosc 14(1):71–74PubMedCrossRefGoogle Scholar
  18. 18.
    Gallagher AG, Ritter EM, Lederman AB, McClusky DA 3rd, Smith CD (2005) Video-assisted surgery represents more than a loss of three-dimensional vision. Am J Surg 189(1):76–80PubMedCrossRefGoogle Scholar
  19. 19.
    Wagner OJ, Hagen M, Kurmann A, Horgan S, Candinas D, Vorburger SA (2012) Three-dimensional vision enhances task performance independently of the surgical method. Surg Endosc 26(10):2961–2968PubMedCrossRefGoogle Scholar
  20. 20.
    Kunert W, Storz P, Kirschniak A (2013) For 3D laparoscopy: a step toward advanced surgical navigation: how to get maximum benefit from 3D vision. Surg Endosc 27(2):696–699PubMedCrossRefGoogle Scholar
  21. 21.
    Storz P, Buess GF, Kunert W, Kirschniak A (2012) 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc 26(5):1454–1460PubMedCrossRefGoogle Scholar
  22. 22.
    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(3):154–158PubMedCrossRefGoogle Scholar
  23. 23.
    Falk V, Mintz D, Grunenfelder J, Fann JI, Burdon TA (2001) Influence of three-dimensional vision on surgical telemanipulator performance. Surg Endosc 15(11):1282–1288PubMedCrossRefGoogle Scholar
  24. 24.
    Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91(2):146–150PubMedCrossRefGoogle Scholar
  25. 25.
    Servos P (2000) Distance estimation in the visual and visuomotor systems. Exp Brain Res 130(1):35–47PubMedCrossRefGoogle Scholar
  26. 26.
    Otto KJ, Hapner ER, Baker M, Johns MM 3rd (2006) Blinded evaluation of the effects of high definition and magnification on perceived image quality in laryngeal imaging. Ann Otol Rhinol Laryngol 115(2):110–113PubMedGoogle Scholar
  27. 27.
    Thomsen MN, Lang RD (2004) An experimental comparison of 3-dimensional and 2-dimensional endoscopic systems in a model. Arthroscopy 20(4):419–423PubMedCrossRefGoogle Scholar
  28. 28.
    Rabin J (1995) Two eyes are better than one: binocular enhancement in the contrast domain. Ophthal Physiol Opt 15(1):45–48CrossRefGoogle Scholar
  29. 29.
    Hoffman DM, Girshick AR, Akeley K, Banks MS (2008) Vergence-accommodation conflicts hinder visual performance and cause visual fatigue. J Vision 8(3):1–30CrossRefGoogle Scholar
  30. 30.
    Hanna GB, Cresswell AB, Cuschieri A (2002) Shadow depth cues and endoscopic task performance. Arch Surg 137(10):1166–1169PubMedCrossRefGoogle Scholar
  31. 31.
    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(9098):248–251PubMedCrossRefGoogle Scholar
  32. 32.
    Mueller-Richter UD, Limberger A, Weber P, Spitzer W, Schilling M (2003) Comparison between three-dimensional presentation of endoscopic procedures with polarization glasses and an autostereoscopic display. Surg Endosc 17(3):502–504PubMedCrossRefGoogle Scholar
  33. 33.
    Silvestri M, Simi M, Cavallotti C, Vatteroni M, Ferrari V, Freschi C, Valdastri P, Menciassi A, Dario P (2011) Autostereoscopic three-dimensional viewer evaluation through comparison with conventional interfaces in laparoscopic surgery. Surg Innov 18(3):223–230PubMedCrossRefGoogle Scholar
  34. 34.
    Computer Assisted Radiology and Surgery (2013) Special Session on Medical 3D Visualization on June 27, 2013 and related discussion during the session. In: The 27th International Congress and Exhibition of Computer Assisted Radiology and Surgery, Heidelberg, GermanyGoogle Scholar
  35. 35.
    Rogers B (2009) Motion parallax as an independent cue for depth perception: a retrospective. Perception 38(6):907–911PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • D. Wilhelm
    • 1
    • 2
  • S. Reiser
    • 2
  • N. Kohn
    • 2
  • M. Witte
    • 3
  • U. Leiner
    • 3
  • L. Mühlbach
    • 3
  • D. Ruschin
    • 3
  • W. Reiner
    • 3
  • H. Feussner
    • 1
    • 2
  1. 1.Department of Surgery, Klinikum rechts der IsarTechnical University MunichMünchenGermany
  2. 2.MITI working group for minimally invasive therapy and interventionTechnical University of MunichMünchenGermany
  3. 3.Fraunhofer Heinrich Hertz InstituteBerlinGermany

Personalised recommendations