Taffinder N, Smith S G, Huber J, Russell R C, Darzi A
Minimal Access Surgical Unit, Imperial College School of Medicine at St. Mary's, Praed Street, London W2 1NY, UK.
Surg Endosc. 1999 Nov;13(11):1087-92. doi: 10.1007/s004649901179.
Endoscopic surgeons rely on visual feedback to control their movements but lack stereopsis, an important depth cue. Previous three-dimensional (3D) systems alternated images on a two-dimensional (2D) screen, which was uncomfortable for surgeons. A second-generation 3D system provides continuous stereoscopic images on a monitor suspended at arm's length. We studied its effect on the laparoscopic precision of novices and experienced surgeons.
Experienced laparoscopic surgeons (n = 12) and novices (n = 16) performed a total of 672 tasks in 2D, 3D, and under direct vision. Precision was assessed using the Imperial College Surgical Assessment Device (ICSAD), which generates objective scores of performance by analyzing the movements of surgical instruments.
We found that 2D endoscopic vision impaired performance by 35-100% when compared with direct vision, whereas 3D reduced this endoscopic handicap by 41-53% in novices and experienced surgeons (p < 0.03). No side effects were reported with the new 3D system. Even in 2D, novices performed better with an image at arm's length (p < 0. 03).
Second-generation 3D significantly improved the laparoscopic precision of novices and experienced surgeons, without the side effects reported from previous systems. This technology is expected to improve the ease and safety of laparoscopic surgery.
内镜外科医生依靠视觉反馈来控制动作，但缺乏立体视觉这一重要的深度线索。以往的三维（3D）系统在二维（2D）屏幕上交替显示图像，这让外科医生感到不适。第二代3D系统在一臂距离悬挂的监视器上提供连续的立体图像。我们研究了其对新手和经验丰富的外科医生腹腔镜操作精度的影响。
经验丰富的腹腔镜外科医生（n = 12）和新手（n = 16）在二维、三维及直视条件下共完成672项任务。使用帝国理工学院手术评估设备（ICSAD）评估精度，该设备通过分析手术器械的动作生成客观的操作评分。
我们发现，与直视相比，二维内镜视觉使操作性能降低35 - 100%，而三维视觉在新手和经验丰富的外科医生中使这种内镜操作障碍降低了41 - 53%（p < 0.03）。新的3D系统未报告有副作用。即使在二维条件下，新手在一臂距离观看图像时操作表现更好（p < 0.03）。
第二代3D技术显著提高了新手和经验丰富的外科医生的腹腔镜操作精度，且没有以往系统所报告的副作用。这项技术有望提高腹腔镜手术的便捷性和安全性。
