Influence of two-dimensional and three-dimensional imaging on endoscopic bowel suturing

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.