Archive Surgery's Hottest Trends 2014

Why 3D Still Matters

Depth perception brings several advantages to surgical imaging.

Gerald Andriole, MD


3D visualization IN DEPTH 3D visualization can boost laparoscopic abilities for experienced hands as well as those just entering the learning curve.

We live in a three-dimensional world, but our direct experience in minimally invasive procedures has long been limited to two dimensions on a display monitor. The development of 3D imaging in laparoscopic cameras and C-arms, however, has brought needed depth perception to a host of surgical specialties. While the technology may not have caught on as rapidly as high-definition resolution has, there are strong prospects for 3D imaging's widespread adoption. Here are 4 reasons why.

1. Improved surgical skills
Does 3D visualization improve surgical outcomes? That question is still subject to anecdotal evidence and lively debate. Does it give a boost to laparoscopic surgeons' abilities? According to a growing number of clinical studies, the answer is an unqualified yes.

My colleagues and I compared the impact of 2D and 3D visualization on laparoscopic performance for a study published in the November 2012 issue of the Journal of Laparoendoscopic & Advanced Surgical Techniques ( We set 33 participants with varying levels of laparoscopic experience to the task of completing 3 drills from the Fundamentals of Laparoscopic Surgery Skill Set — peg transfer, pattern cutting and suturing/knot-tying — in both conventional 2D laparoscopic view and with 3D image guidance.

The participants were randomized as to which visual modality they used first. We measured the amount of time it took them to complete the exercises and the number of attempts required for them to achieve proficiency. We also surveyed them with a questionnaire afterward.

In each of the exercises, the participants averaged greater speeds to completion with 3D visualization, by a wide margin. Regardless of their level of laparoscopic expertise, they made fewer errors in 3D. Fewer participants required multiple attempts to reach proficiency using 3D.

We found no differences in participants' reports of eye strain, headaches or other physiological side effects after using each visual modality. Subjectively speaking, nearly 88% of the participants preferred the 3D view. It stands to reason that a visualization technology that improves skill and that physicians are comfortable with can deliver more efficient and more cost-effective surgeries.

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