The effect of high-definition imaging on surgical task efficiency in minimally invasive surgery

Background: In 1995, when we first used a high-definition television (HDTV) video system during a laparoscopic cholecystectomy in Tuebingen, we were surprised by the excellence of the spatial impression achieved by an image with improved resolution. Although any improvement in vision systems entails a trade-off among cost, quality, and complexity, high-definition imaging may well become an essential part of 3-D video systems. The aim of this experimental study was to assess the impact of high definition on surgical task efficiency in minimally invasive surgery and to determine whether it is preferable to use a 3-D system or a 2-D system with perfect resolution and color—for instance, HDTV or the three-chip charge-coupled device (3CCD). Methods: We compared a 3-D video system with the vision through a stereoscopic rectoscope for transanal endoscopic microsurgery (TEM). Because its stereoscopic direct vision is not restricted to either shutter technology or video resolution, TEM optics represents the state of the art. For objective comparison, inanimate phantom models with suturing tasks were set up. The setups allowed the approach of parallel instruments as in TEM operations or via a laparoscopic approach, with oblique instruments coming laterally. Both types of procedure were carried out by highly experienced laparoscopic surgeons as well as those inexperienced in endoscopic surgery. These volunteers worked under 3-D video vision and/or TEM vision. Altogether, the model tasks 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 benefit of a higher resolution. Conclusion: We found a tendency for both endoscopically inexperienced and experienced surgeons to benefit from the use of a system with improved resolution (direct vision) rather than a 3-D shutter video system. Received: 9 November 1998/Accepted: 19 April 1999