The effects of different viewing conditions on performance in simulated minimal access surgery

This study aimed to assess performance in simulated minimal access surgery (MAS) tasks under a range of viewing conditions. MAS conventionally uses 2d viewing systems which produce a flat image. However, 3d viewing systems which produce stereoscopic depth information should in principle lead to better depth perception, and improve performance on tasks which require appropriate spatial representation of layout and depth. The study compared a novel 3d viewing system with a state of the art 2d viewing system and a direct viewing condition ('open surgery') as a point of reference. Tasks included pulling and cutting of threads using standard surgical instruments. Medical students (n = 16) were allocated to viewing conditions according to a Latin square and carried out 120 tasks each. Assessment was by means of a 3d movement tracking device providing a number of performance parameters (time on task, velocity, number of movements, distance travelled). In addition instrument movement was video-recorded and analysed by four observers to validate the tracking device. Results from tracking data and observer data were highly correlated (r > 0.85). While open surgery naturally scored highest, the key finding was the clearly superior performance in the 3d condition compared to 2d. Thus modern 3d viewing systems can improve performance in a realistic task.