A computerized assessment to compare the impact of standard, stereoscopic, and high-definition laparoscopic monitor displays on surgical technique

Abstract

Background: Surgeons performing laparoscopic surgery have strong biases regarding the quality and nature of the laparoscopic video monitor display. In a comparative study, we used a unique computerized sensing and analysis system to evaluate the various types of monitors employed in laparoscopic surgery.

Methods: We compared the impact of different types of monitor displays on an individual's performance of a laparoscopic training task which required the subject to move the instrument to a set of targets. Participants (varying from no laparoscopic experience to board-certified surgeons) were asked to perform the assigned task while using all three display systems, which were randomly assigned: a conventional laparoscopic monitor system (2D), a high-definition monitor system (HD), and a stereoscopic display (3D). The effects of monitor system on various performance parameters (total time consumed to finish the task, average speed, and movement economy) were analyzed by computer. Each of the subjects filled out a subjective questionnaire at the end of their training session.

Results: A total of 27 participants completed our study. Performance with the HD monitor was significantly slower than with either the 3D or 2D monitor (p < 0.0001). Movement economy with the HD monitor was significantly reduced compared with the 3D (p < 0.0004) or 2D (p < 0.0001) monitor. In terms of average time required to complete the task, performance with the 3D monitor was significantly faster than with the HD (p < 0.0001) or 2D (p < 0.0086) monitor. However, the HD system was the overwhelming favorite according to subjective evaluation.

Conclusion: Computerized sensing and analysis is capable of quantitatively assessing the seemingly minor effect of monitor display on surgical training performance. The study demonstrates that, while users expressed a decided preference for HD systems, actual quantitative analysis indicates that HD monitors offer no statistically significant advantage and may even worsen performance compared with standard 2D or 3D laparoscopic monitors.