Visual clues in minimally invasive surgery: use of 2-D versus 6-D enhanced performance of complex minimally invasive...

In the recent past, we used two 2-D videoscopes to obtain both a close detailed view and simultaneously a panoramic view to improve the efficient and safe access for instruments into the microscopic working field by way of the benefits of the panoramic view. This bi-modal visual set of clues allows for (1) insertion of suture, (2) cutting of suture with scissors (3) retraction of tissue, and (4) removal of suture and needle. During these experiences, we observed the benefits accrued to the surgeon by allowing the focusing of his/her attention on the work (technical skills) without diffusing energy to other activities. Similarly, when training surgeons to perform micro-anastomoses, and while working to improve performance in micro-anastomoses, we hypothesize that two or more videoscopic views of the 3-dimensional working space would provided added visual information to the surgeon during the microscopic work. To examine this hypothesis, we have used a non-animate model, in the performance of complex skills in videoscopic surgery.

Inanimate videoscopic models for suturing and tying (24 studies) were used in this study. The technical skill studied was the sophisticated skill of suturing. The speed and accuracy of Free-Handed suturing and tying was determined in these studies. They were compared using a single 2-D system verses three videoscopic views reconstructing a 3-D effect.

In each of these models, the delineation of multiple views allowed greater detailed 3-dimensional information for the surgeon. The sutures were placed faster, more accurately, and with fewer false motions. These data allow us to conclude the use of multiple high-resolution 2-D views will improve accuracy and efficiency in the performance of delicate and precise skills in videoscopic surgery.