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

Background: In 1995, when we first used a high-definition television (HDTV) video system during a laparoscopic cholecystectomy in Tuebingen, we were s urprised by the excellence of the spatial impression achieved by an image w ith improved resolution. Although any improvement in vision systems entails a trade-off among cost, quality, and complexity, high-definition imaging m ay well become an essential part of 3-D video systems. The aim of this expe rimental study was to assess the impact of high definition on surgical task efficiency in minimally invasive surgery and to determine whether it is pr eferable to use a 3-D system or a 2-D system with perfect resolution and co lor-for instance, HDTV or the three-chip charge-coupled device (3CCD). Methods: We compared a 3-D video system with the vision through a stereosco pic rectoscope for transanal endoscopic microsurgery (TEM). Because its ste reoscopic direct vision is not restricted to either shutter technology or v ideo resolution, TEM optics represents the state of the art. For objective comparison, inanimate phantom models with suturing tasks were set up. The s etups allowed the approach of parallel instruments as in TEM operations or via a laparoscopic-approach, with oblique instruments coming laterally. Bot h types of procedure were carried out by highly experienced laparoscopic su rgeons as well as those inexperienced in endoscopic surgery. These voluntee rs worked under 3-D video vision and/or TEM vision. Altogether, the model t asks were performed by 54 different persons. Results: The evaluation did not show a significant (p > 0.05) difference in performance time in all models, but there was a clear trend showing the be nefit of a higher resolution. Conclusion: We found a tendency for both endoscopically inexperienced and e xperienced surgeons to benefit from the use of a system with improved resol ution (direct vision) rather than a 3-D shutter video system.