A PROSPECTIVE RANDOMIZED EXPERIMENTAL EVALUATION OF 3-DIMENSIONAL IMAGING IN LAPAROSCOPY

Background: Restricted depth perception in laparoscopy with two-dimens ional imaging has been reported to be a major disadvantage of minimall y invasive procedures. Three-dimensional imaging units have been avail able for almost 2 years and are slowly being integrated into endoscopi c surgery. So far, potential advantages or disadvantages have not yet been studied prospectively. Methods: We evaluated the effects of three -dimensional imaging on surgical performance and its influence on surg eons at different experience levels in a prospective randomized trial. Twenty participants without laparoscopic experience (novices), 20 wit h less than 50 laparoscopic procedures (beginners), and 20 with more t han 50 laparoscopic procedures (advanced surgeons) took part in two di fferent tests (tube test and loop test) on a pelvitrainer. In random o rder, each test was conducted using a three-dimensional imaging unit u nder two-dimensional and three-dimensional conditions. During each tes t, the time was measured and the mistakes counted. The difference of t ime and number of mistakes for two-dimensional and three-dimensional c onditions were calculated for each participant. Results: Speed (p < 0. 0001) and accuracy (p < 0.0001) were significantly better under three- dimensional conditions irrespective of the randomized sequence of each individual test. Speed was also influenced by individual experience ( p > 0.02). Performance time decreased by 24.4% +/- 2.8% (m +/- SD), an d the number of mistakes decreased by 52.5% +/- 27.9% (m +/- SD), as c ompared with the two-dimensional mode, with no significant influence o f individual experience. Conclusions: Three-dimensional imaging signif icantly improves performance (speed and accuracy) regardless of previo us laparoscopic experience. Thus, three-dimensional imaging may furthe r improve the safety aspect of minimally invasive surgery.