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Comparison of two- and three-dimensional camera systems in laparoscopic performance: A novel 3D system with one camera

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Seong-Ho Kong at Seoul National University Hospital
Seong-Ho Kong
Byung-Mo Oh at Seoul National University
Byung-Mo Oh
Hongman Yoon
Hongman Yoon
Hongman Yoon
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Hye Seong Ahn
Hye Seong Ahn
Hye Seong Ahn
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Abstract

This study evaluated the effects of a three-dimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system. In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles. The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system. The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery.
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Artículo
Comparison of two- and three-dimensional
camera systems in laparoscopic performance: a
novel 3D system with one camera
Publicación Surgical Endoscopy
Editor Springer New York
ISSN 0930-2794 (Print) 1432-2218
(Online)
DOI 10.1007/s00464-009-0740-8
Subject Collection Medicina.
Fecha de SpringerLink viernes, 13 de noviembre de 2009
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Seong-HoKong1 , Byung-MoOh2, Hongman Yoon1,
HyeSeongAhn1, Hyuk-JoonLee1, Sun Geun Chung2,
NorioShiraishi3, Seigo Kitano3 and Han-KwangYang1
Received: 25April2009Accepted: 12October2009Published online:
13November2009
Abstract
BackgroundThis study evaluated the effects of a three-
dimensional (3D) imaging system on laparoscopy performance
compared with the conventional 2D system using a novel one-
camera 3D system.
MethodsIn this study, 21 novices and 6 experienced surgeons
performed two tasks with 2D and 3D systems in 4 consecutive
days. Performance time and error as well as subjective
parameters such as depth perception and visual discomforts were
assessed in each session. Electromyography was used to
evaluate the usage of muscles.
ResultsThe 3D system provided significantly greater depth
perception than the 2D system. The errors during the two tasks
were significantly lower with 3D system in novice group, but
performance time was not different between the 2D and 3D
systems. The novices had more dizziness with the 3D system in
first 2 days. However, the severity of dizziness was minimal (less
than 2 of 10) and overcome with the passage of time. About
54% of the novices and 80% of the experienced surgeons
preferred the 3D system. Electromyography (EMG) showed a
tendency toward less usage of the right arm and more usage of
the left arm with the 3D system.
ConclusionThe new 3D imaging system increased the accuracy
of laparoscopy performance, with greater depth perception and
only minimal dizziness. The authors expect that the 3D
laparoscopic system could provide good depth perception and
accuracy in surgery.
KeywordsImaging and virtual reality -Surgical-
Training
(1) Department of Surgery, Seoul National University College of Medicine, 28
Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
(2)
Department of Rehabilitation Medicine, Seoul National University College of
Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
(3) Department of Surgery I, Faculty of Medicine, Oita University, Oita, Japan
Seong-HoKong
Email: wisehearted@gmail.com
Han-KwangYang(Correspondingauthor)
Email: hkyang@snu.ac.kr
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... Nowadays, the 4th generation 3D techniques have been improved in comparison to the first generation of 3D vision system introduced in the 90s and can be even replaced by the classic bi-dimensional view (Zobel, 1993;Mueller et al., 1999;Bove et al., 2015). The 4th generation 3D system uses more ergonomic glasses and an innovated technology which gives a better depth perception that cannot be achieved with traditional 2D systems, without any complaints of visual strains (Kong et al., 2010). This depth perception and hand eye coordination were excellent with 3D imaging system in this study, leading to accurate and swift dissection as well as better intra-corporeal knotting to achieve blood vessels division and suture without compromising the safety and operative time. ...
... Unfortunately, conventional laparoscopy is limited by a 2D vision that does not allow perception of the operative field as in open surgery (Taffinder et al., 1999;Wilhelm et al., 2014). Therefore, surgeons lose depth perception and spatial orientation, and thus experience a higher visual and cognitive load (Kong et al., 2010;Lusch et al., 2014;Smith et al., 2014). For this reason and through the popularity of laparoscopy, besides increasing the resolution of applied camera systems, 3D reproduction of the operative field is improving (van Bergen et al., 2000 (Peitgen et al., 1996;Badani et al., 2005;Patel et al., 2007). ...
Three-Dimensional (3D) Laparoscopy Versus Two-Dimensional (2D) Laparoscopy: A Single-Surgeon Prospective Randomized Comparative Study
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Background: Visual information is crucial for performing laparoscopic surgery. While surgeons lose depth perception and spatial orientation in conventional 2D laparoscopy, the 4th generation 3D system gives a better depth perception. Objective: In this sstudy, we aimed to investigate the feasibility, safety, and short-term efficacy of 4th generation 3D-HD visualization technology applied in laparoscopic colon cancer surgery. Methods: One hundred and twenty patients with colon adenocarcinoma were recruited in this study. Patients were randomized on the day of surgery by a random computer-generated allocation list to undergo either a 3D-HD display or 2D-HD imaging system laparoscopic colon cancer surgery. In total, 60 patients underwent laparoscopic colon resection by 3D-HD laparoscope (3D group) and 60 patients underwent 2D-HD laparoscope (2D group). After the insertion of the access ports, both surgical procedures were divided in component tasks, and the execution times were compared. Data analysis was done using SPSS (version 15.0). Quantitative and qualitative variables were compared applying Student t test and Pearson's chi-square test. Results: Two groups were homogenous in terms of demographic data. Operation time was significantly shorter for the 3D group than for the 2D group (123.2±34.2 min vs. 142.2±23.5 min, P=0.018). There was no statistically significant difference between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery, and postoperative complications (P>0.05). Conclusion: The 4th generation 3D-HD vision system reduced the operating time compared to 2D-HD vision system. It seems that use of the 3D-HD technology can significantly enhance the possibility of achieving better intraoperative results. .
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... Due to the drawbacks such as inducing fatigue and damaging visual acuity in surgical practice, the adoption of 3D LRP has been slow in clinical settings. The latest advances in 3D laparoscopic technology have significantly improved the performance, precision, and hand-eye coordination of laparoscopic surgery, while providing greater depth perception during the surgical process and minimizing dizziness for surgeons (25,26). Therefore, in recent years, there has been a resurgence in 3D laparoscopic surgery. ...
Comparison of perioperative, oncologic, and functional outcomes between 3D and 2D laparoscopic radical prostatectomy: a systemic review and meta-analysis
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Objectives Literature regarding experience with 3D laparoscopy about prostatectomy has remained scanty, and this could be related to the rise of robotic assisted laparoscopic surgery. This study aimed to perform a systemic review and meta-analysis to evaluate the perioperative, functional, and oncologic outcomes between 3D and 2D laparoscopic radical prostatectomy (LRP). Methods We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared perioperative, functional, or oncologic outcomes of both 3D and 2D LRP. The Newcastle-Ottawa Scale (NOS) tool and Jadad scale were used to assess the risk of bias in the included studies. Review Manager 5.3 was used for the meta-analysis. Results Seven studies with a total of 542 patients were included in the analysis. Among them, two were RCTs. There was no difference between groups in terms of preoperative characteristics. Anastomosis time, hospital day, and overall complication rates were similar in 3D than 2D group. However, operative time [mean difference (MD) -36.96; 95% confidence interval [CI] -59.25 to -14.67; p = 0.001], blood loss (MD -83.5; 95% CI -123.05 to -43.94; p <0.0001), and days of drainage (MD -1.48; 95% CI -2.29 to -0.67; p = 0.0003) were lower in 3D LRP. 2D and 3D LRP showed similarity in the positive surgical margin (PSM) rate and biochemical recurrence (BCR) rate at 3, 6, and 12months postoperatively. Additionally, there was no significant differences in continence and potency recovery rate between two group except higher continence rate of 3D LRP at 3 months. Conclusion Current evidence shows that 3D LRP offers favorable outcomes compared with 2D LRP, including operative time, blood loss, days of drainage, and early continence. However, there was no conclusive evidence that 3D LRP was advantaged in terms of oncologic and functional outcomes (except for continence rate at 3 months). Systematic review registration The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023426403).
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... To provide depth perception in telesurgery, researchers use head-mounted binocular display [8] and glasses-based binocular display [9] to show 3D surgical scenes. The problem was the discomfort associated with wearing 3D glasses, as well as visual fatigue and dizziness [10,11]. Compared with binocular display, autostereoscopic 3D display has the advantages of no additional equipment, support for multi-person observation, and lower visual fatigue [12,13], which has preliminary applications in augmented reality surgical navigation [14,15]. ...
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Purpose: The visualization of remote surgical scenes is the key to realizing the remote operation of surgical robots. However, current non-endoscopic surgical robot systems lack an effective visualization tool to offer sufficient surgical scene information and depth perception. Methods: We propose a novel autostereoscopic surgical visualization system integrating 3D intraoperative scene reconstruction, autostereoscopic 3D display, and augmented reality-based image fusion. The preoperative organ structure and the intraoperative surface point cloud are obtained from medical imaging and the RGB-D camera, respectively, and aligned by an automatic marker-free intraoperative registration algorithm. After registration, preoperative meshes with precalculated illumination and intraoperative textured point cloud are blended in real time. Finally, the fused image is shown on a 3D autostereoscopic display device to achieve depth perception. Results: A prototype of the autostereoscopic surgical visualization system was built. The system had a horizontal image resolution of 1.31 mm, a vertical image resolution of 0.82 mm, an average rendering rate of 33.1 FPS, an average registration rate of 20.5 FPS, and average registration errors of approximately 3 mm. A telesurgical robot prototype based on 3D autostereoscopic display was built. The quantitative evaluation experiments showed that our system achieved similar operational accuracy (1.79 ± 0.87 mm) as the conventional system (1.95 ± 0.71 mm), while having advantages in terms of completion time (with 34.11% reduction) and path length (with 35.87% reduction). Post-experimental questionnaires indicated that the system was user-friendly for novices and experts. Conclusion: We propose a 3D surgical visualization system with augmented instruction and depth perception for telesurgery. The qualitative and quantitative evaluation results illustrate the accuracy and efficiency of the proposed system. Therefore, it shows great prospects in robotic surgery and telesurgery.
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... Most of them used validated phantom exercises like E-BLUS and FLS models. The advantages found for new 3D systems were shorter learning curve for novices [4][5][6][7], faster performance [5,7,8], error reduction [4,9,10], surgeons preference [8,[10][11][12], and reduced strain [9]. ...
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... One challenge is that the surgeons must complete tasks within three-dimensional (3D) spaces while depending on two-dimensional (2D) images [5,6]. The consequent lack of depth perception and spatial orientation increases the visual and cognitive loads of the tasks [7][8][9]. ...
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Objective: Since Augmented Reality (AR) and 3D visualization have proven to be of great significance to the safety and effectiveness of surgical outcomes, will autostereoscopic 3D AR without glasses bring new opportunities for surgical navigation of laparoscopic surgery? Methods: We used the CPD-based deformation registration algorithm and the proposed virtual view generation algorithm, realizing a deformable autostereoscopic 3D AR navigation framework for laparoscopic surgery. The depth perception and user experience of the 3D AR navigation were evaluated compared with the 2D AR display using an in-vitro porcine heart and offline clinical partial nephrectomy laparoscopic images. Results: The autostereoscopic 3D AR allowed participants to have a more consistent spatial perception as well as a shorter measuring time than 2D AR with significant difference of p<0.05. It can also improve relative depth perception for smaller distance separation of objects < = 3.28 mm. However, the autostereoscopic 3D AR perceived a worse experience compared to 2D AR in the user experience. Conclusion: Autostereoscopic 3D AR shows a more efficient and robust sense of spatial scale than 2D AR with better potential to shorten the operating time and improve surgical outcomes than 2D AR, but image blur and distortion are issues that must be solved to improve the perception effect. High precise registration and high fluency visualization requirements could make autostereoscopic 3D AR navigation for soft tissue more challenging. Significance: Our work lays a theoretical foundation for the further development of laparoscopic surgical navigation.
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Exoscopic surgery of lateral skull base
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  • Jan 2022
Exoscopic surgery, a new surgical technique that combines the features of an endoscopic approach (surgeon looking at a monitor) and the ones of microscopic surgery (two-handed technique), has the purpose of using the exoscope to replace the operative microscope in lateral skull-base surgery. A 3D exoscope provides both the surgeon and his assistants with the same three-dimensional images, it has a small frame and a large depth of field reducing the need to refocus, it is easy to shift from a microscopic to a macroscopic vision, and it allows for an ergonomic position of the surgeon. From our experience, the VITOM 3D exoscope can be successfully used on soft tissue, bone tissue, and for pathology removal, in lateral skull-base surgery with a large surgical field. For instance, it can successfully replace the functions of the microscope for lateral and anterior transpetrous surgical techniques, sometimes with endoscopic assistance.
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  • Oct 1996
  • GASTROINTEST ENDOSC
Restricted depth perception in laparoscopy with two-dimensional imaging has been reported to be a major disadvantage of minimally invasive procedures. Three-dimensional imaging units have been available for almost 2 years and are slowly being integrated into endoscopic surgery. So far, potential advantages or disadvantages have not yet been studied prospectively. We evaluated the effects of three-dimensional imaging on surgical performance and its influence on surgeons at different experience levels in a prospective randomized trial. Twenty participants without laparoscopic experience (novices), 20 with less than 50 laparoscopic procedures (beginners), and 20 with more than 50 laparoscopic procedures (advanced surgeons) took part in two different tests (tube test and loop test) on a pelvitrainer. In random order, each test was conducted using a three-dimensional imaging unit under two-dimensional and three-dimensional conditions. During each test, the time was measured and the mistakes counted. The difference of time and number of mistakes for two-dimensional and three-dimensional conditions were calculated for each participant. Speed (p < 0.0001) and accuracy (p < 0.0001) were significantly better under three-dimensional conditions irrespective of the randomized sequence of each individual test. Speed was also influenced by individual experience (p > 0.02). Performance time decreased by 24.4% +/- 2.8% (m +/- SD), and the number of mistakes decreased by 52.5% +/- 27.9% (m +/- SD), as compared with the two-dimensional mode, with no significant influence of individual experience. Three-dimensional imaging significantly improves performance (speed and accuracy) regardless of previous laparoscopic experience. Thus, three-dimensional imaging may further improve the safety aspect of minimally invasive surgery.
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Using movement parallax for 3D laparoscopy
Article
Full-text available
  • Jan 1996
The lack of depth perception hampers the surgeon during laparoscopic operation. Laparoscopes usually are monocular, but binocular ones are currently available. Depth perception, however, does not exclusively rely on binocular disparity. An observer, with only one eye, who is able to move that eye, obtains the same information as an observer who has two eyes. This principle of movement parallax can be applied to laparoscopy by coupling the head movements of the surgeon to the motions of the tip of the laparoscope. In an experiment we investigated if this principle is applicable to laparoscopy. Two groups of testees with no background in surgery were used. The first group was assisted by movement parallax, the second group was viewing a static image. Both groups of testees had to perform an exploration and a manipulation task. Since the amount of space for camera motion within the laparoscope is limited, implementation potential depends on the amount of movements that will be made by the observer. Therefore the movements of the observer performing the exploration task were registered and analysed. Results of the experiment indicate the advantage of movement parallax for the exploration task (performance increases by factor 2 while using only 30% more time) but not for the manipulation task. The analysis of the movements indicates that small movements are sufficient for implementation. Based on these results we concluded that movement parallax is applicable to laparoscopy.
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Comparison of Three-Dimensional and Two-Dimensional Laparoscopic Video Systems
Article
  • Sep 1996
The limitations of two-dimensional (2D) video may be overcome by the recent introduction of the three-dimensional (3D) laparoscope and video system. Twenty-two urologic and gynecologic surgeons experienced in laparoscopy were evaluated during a live porcine laboratory session in an advanced course designed to teach laparoscopic retroperitioneal nephrectomy and bladder neck suspension. The surgeons performed dissection of the kidney, securing of the renal vessels, laparoscopic suturing and intracorporeal knot-tying at the bladder neck, and suture clipping of an intracorporeally placed suture at the bladder neck using 2D and 3D equipment. The time needed to complete each technique was recorded and compared using nonparametric analysis. The participants' subjective evaluation of the 3D system was also analyzed. Three-dimensional video did not significantly improve the surgeons' ability to perform laparoscopic dissection of the kidney, securing the renal vessels, or laparoscopic suturing and knot-tying. Surgeons felt that the 3D system did not improve vision or perceived surgical performance sufficiently to justify an expense greater than that of the 2D systems now available. Compared with the standard 2D camera system, the currently available 3D video system does not hasten the laparoscopic dissection of tissues or the performance of advanced technical maneuvers such as laparoscopic suturing and knot-tying by experienced laparoscopists.
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The 3-D monitor and head-mounted display
Article
  • Aug 1999
Background: Stereoscopic (3-D) monitors and head-mounted displays have promised to facilitate laparoscopic surgery by increasing positional accuracy and decreasing operative time. To test this hypothesis, we evaluated the performance of subjects using these displays to perform standardized laparoscopic dexterity drills. Methods: Fifty laparoscopic novices worked within an abdominal cavity simulator using four videoscopic display configurations: (1) standard (2-D) monitor; (2) 3-D monitor; (3) 2-D head-mounted display; and (4) 3-D head-mounted display. Subjects repeated 3 standardized training exercises 2 times. We measured time to complete each drill and number of errors committed. Results: Mean total times to complete all 3 drills were 455, 459, 485, and 449 sec for configurations 1–4, respectively. Mean total errors committed numbered 11.3, 10.4, 12.3, and 10.8, respectively. Neither comparison reached statistical significance (p < 0.05). When 3-D configurations were compared to 2-D configurations overall, a small but statistically significant reduction in errors was noted for 1 drill only (4.3 vs 5.0, p= 0.018). Conclusions: Three-dimensional imaging slightly reduced the number of errors committed by laparoscopic novices during one test drill; this improvement, however, was not clinically significant. Neither the 3-D monitor nor the head-mounted display decreased task performance time. Widespread adoption of this technology awaits future improvement in display resolution and ease of use.
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Influence of Two-dimensional and Three-dimensional Imaging on Endoscopic Bowel Suturing
Article
  • Apr 2000
Several three-dimensional (3-D) video-endoscopic systems have been introduced in surgical practice to enhance depth perception during minimal access surgery (MAS), but the facilitation of endoscopic manipulations by the current 3-D systems remains unproved. The aim of the study was to investigate the influence of 2-D and 3-D imaging modalities on intracorporeal suturing. The standard task consisted of suture closure of 60 mm enterotomies made in porcine small bowel with continuous seromuscular 3/0 Polysorb. Ten experienced surgeons participated in the study. The imaging systems were Storz (2-D), Welch Allyn (3-D), and Zeiss (as both 2-D and 3-D). Each surgeon performed two tasks with each modality in a random sequence. The outcome measures were execution time, suture line leakage pressure, and suture placement score. In addition, the participating surgeons assigned subjective scores on the image quality and the adverse effects of the imaging systems. There was no significant difference in the execution time, leakage pressure, and suture placement score among the various imaging modalities. Depth perception was rated as similar with 2-D and 3-D imaging. Surgeons experienced visual strain with the three systems, but it was rated higher with 3-D imaging. With the current technology, we have not documented any significant difference in task efficiency and quality of endoscopic bowel suturing by trained surgeons between 2-D and 3-D imaging systems.
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A new 3-D laparoscope in gastrointestinal surgery
Article
  • Jan 1995
This study was set up to compare three-dimensional imaging of a new three-dimensional laparoscope with two-dimensional imaging in the inanimate and clinical settings. In the clinical setting the laparoscope was used in a total of 50 different laparoscopic operations. It provided excellent depth perception, definition, and resolution. The relationships of structures were more easily defined, and instrument manipulation was easier, doing away with the need for "touch and feel" to determine instrument position. Three-D imaging made cannulation of the cystic duct for cholangiography or with a flexible choledochoscope easier. In the inanimate setting basic simple tasks took the same time in 2-D as in 3-D, whereas a more complicated procedure of passing a needle and suture through a series of hoops was 25% faster when performed in 3-D compared to 2-D. Three-D imaging may reduce operative time for laparoscopic procedures, particularly the more complicated operations.
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D video techniques in endoscopic surgery. Endosc Surg Allied Technol 1: 40-46
Article
  • Mar 1993
Three-dimensional visualisation of the operative field is an important requisite for precise and fast handling of open surgical operations. Up to now it has only been possible to display a two-dimensional image on the monitor during endoscopic procedures. The increasing complexity of minimal invasive interventions requires endoscopic suturing and ligatures of larger vessels which are difficult to perform without the impression of space. Three-dimensional vision therefore may decrease the operative risk, accelerate interventions and widen the operative spectrum. In April 1992 a 3-D video system developed at the Nuclear Research Center Karlsruhe, Germany (IAI Institute) was applied in various animal experimental procedures and clinically in laparoscopic cholecystectomy. The system works with a single monitor and active high-speed shutter glasses. Our first trials with this new 3-D imaging system clearly showed a facilitation of complex surgical manoeuvres like mobilisation of organs, preparation in the deep space and suture techniques. The 3-D-system introduced in this article will enter the market in 1993 (Opticon Co., Karlsruhe, Germany.
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