An experimental comparison of 3‐dimensional and 2‐dimensional endoscopic systems in a model ¹

PURPOSE: This study compares the effect of new electronic display systems using endoscopic instruments on intrathoracal maneuvering and targeting under standardized conditions. A 2-dimensional (2-D) vision system is compared with 2 stereoscopic 3-dimensional (3-D) video technologies, called "shutter glasses," and the head-mounted display (HMD) system. METHODS: Fifteen participants with minor experience (<50 operations = beginners) and 15 participants with endoscopic experience (advanced) had to hit 12 electronically conducted wires in a thoracic spine model using 3 different systems (2-D video, 3-D shutter glasses, and 3-D HMD). The sequence was randomly alternated for each participant and repeated 3 times to eliminate the influence of training and concentration. RESULTS: The execution time with the 2-D system (mean time, 95.5 seconds) was shorter than with the HMD (mean time, 107 seconds; P =.001) or the Shutter system (mean time, 101 seconds; P =.002). No significant difference was seen between the 3-D systems (P =.153). The overall look of the missed targets showed statistically no difference between the 3 systems (P =.191). None of the 3 systems showed a statistically significant correlation between execution time and number of missed targets. Regarding the total number of missed targets for advanced and beginner groups, the head-mounted display system in the advanced group showed higher but not statistically significantly higher accuracy. CONCLUSIONS: Although the 3-D systems tested for endoscopic surgery did not accelerate the execution speed, the HMD system seems to increase the accuracy for endoscopically experienced surgeons.