The 3-D monitor and head-mounted display - A quantitative evaluation of advanced laparoscopic viewing technologies

Background: Stereoscopic (3-D) monitors and head-mounted displays have promised to facilitate laparoscopic surgery by increasing positional accuracy and decreasing operative time, To test this hypothesis, we evaluated the performance of subjects using these displays to perform standardized laparoscopic dexterity drills. Methods: Fifty laparoscopic novices worked within an abdominal cavity simulator using four videoscopic display configurations: (1) standard (2-D) monitor; (2) 3-D monitor; (3) 2-D head-mounted display; and (4) 3-D head-mounted display. Subjects repeated 3 standardized training exercises 2 times, We measured time to complete each drill and number of errors committed. Results: Mean total times to complete all 3 drills were 455, 459, 485, and 449 sec for configurations 1-4, respectively. Mean total errors committed numbered 11.3, 10.4, 12.3, and 10.8, respectively. Neither comparison reached statistical significance (p < 0.05). When 3-D configurations were compared to 2-D configurations overall, a small but statistically significant reduction in errors was noted for 1 drill only (4.3 vs 5.0, p = 0.018). Conclusions: Three-dimensional imaging slightly reduced the number of errors committed by laparoscopic novices during one test drill; this improvement, however, was not clinically significant. Neither the 3-D monitor nor the head-mounted display decreased task performance time. Widespread adoption of this technology awaits future improvement in display resolution and ease of use.