Evolution of stereoscopic imaging in surgery and recent advances

Table 1 Single channelled scopes

Ref.	Year	Projection system for 3D	Who and what assessed	Objective outcomes	Subjective outcomes
McDougall et al[6]	1996	Active shuttering screen and glasses	22 urological and gynaecological surgeons, non-novice Pig-lab, laparoscopic vessel dissection and securing, suturing and knot tying	Time for completion. No significant difference found	3D not felt to enhance image quality or enhance performance. Blurred vision and eye fatigue with 3D
Dion et al[7]	1997	Active shuttering screen and glasses	Surgeons and non-surgeons. Lab visual (n = 8) and motor skills (n = 9)	Time and errors. Improvement in both with 3D	Glasses bothersome and dizziness reported
Chan et al[8]	1997	Active shuttering screen and glasses	32 surgeons, 11 with and 21 without laparoscopic experience 1 × lab based skills task	Time for completion in 2D and 3D (1 repetition). No significant difference	50% felt no improved performance although 66% felt depth perception improved 40% felt reduced image quality and dimmer; 10% reported dizziness and eyestrain
Hanna et al[9]	1998	Active shuttering screen and glasses (A/S)	4 surgical SpRs performing 60 laparoscopic cholecystectomies	Time for completion and errors No significant difference	Visual strain, headache and facial discomfort with 3D system
Mueller et al[10]	1999	Active shuttering screen and glasses	30 subjects (10 with and 20 without laparoscopic experience) 4 × lab based skills tasks for all, then experienced did suturing tasks	Time for attempts, and success/failure of attempt No significant difference	Reported loss of concentration, headaches and distraction with 3D system
Herron et al[11]	1999	3D (active shuttering screen and glasses) and 3D HMD	50 laparoscopic novices 3 × lab based skills tasks	Time to completion of 3 skills tasks in each visual system (2 × repitions) No significant difference	Although 48% preferred 3D A/S screen over all, 7% and 25% respectively reported headaches with 3D screen and 3D HMD. 82% found HMD uncomfortable
Mueller-Richter et al[12]	2003	3D (active shuttering screen and polarising glasses) and 3D Autostereoscopic screen	59 laparoscopic novices 3 × lab based skills tasks	Number of completions in time limit and subjective difficulty No significant difference	Flickering reported with both 3D systems
Bhayani et al[13]	2005	HMD	24 surgical residents, minimal laparoscopic experience. 1 × lab based skills task	Time for completion in 2D and 3D (1 repetition) Significant reduction in time	> 50% preferred the 3D system and found task easier in 3D No subjective assessment on physical symptoms
Patel et al[14]	2007	HMD	15 novices and 2 experts 5 × lab based skills tasks	Time and accuracy in 2D and 3D (1 repetition) of the novices compared to the experts Significant difference in both for novices only in 3D	NA
Bittner et al[15]	2008	HMD	2 novices, 2 intermediate and 2 experts 2 × lab based suturing tasks (based on handedness, visual system and articulating needle holder)	Time and accuracy in 2D and 3D (multi repetitions with each variable) No significant difference	83% felt improved depth perception. No reported physical symptoms
Votanopoulos et al[16]	2008	HMD	36 surgical residents and medical students (11 with and 25 without laparoscopic experience) 6 × lab based skills tasks (rpt 3/12 later)	Time and errors in 2D and 3D (1 repetition) Significant improvement in time and errors in novice group only	NA
Kong et al[17]	2009	Passive polarising screen and glasses	21 novices and 6 experienced surgeons 2 × lab based skills tasks	Time and errors in 2D and 3D (4 repetitions of each over 4 d) Significant reduction in errors in 3D novices, no other significant difference noted	Dizziness and eye fatigue in novice with 3D system which improved with time
Mistry et al[18]	2013	Passive polarising screen and glasses	31 medical students (novices) 4 × lab based skills tasks (MISTELS)	Task Performance in 2D and 3D as per MISTELS scoring system No significant difference	No detrimental symptoms with 3D

NA: Not available; 3D: Three-dimensional; 2D: Two-dimensional; HMD: Head mounted display.

Table 2 Dual channel laparoscopes - Robotic fixed screen

Ref.	Year	Projection system for 3D	Who and what assessed	Objective outcomes	Subjective outcomes
Falk et al[19]	2001	Da Vinci	15 experienced laparoscopic surgeons 6 × lab based skills tasks (increasing difficulty)	Time and errors in 2D and 3D and 2DHD (I repetition in each view) Significant differences in time and errors in 3D	Only 33% felt 3D better view No detrimental symptoms reported
Munz et al[20]	2004	Da Vinci	11 experienced laparoscopic surgeons 4 × lab based skills tasks	Errors and performance (ICSAD assessment - time, no. movements and distance moved) Significant difference in both in 3D	NA
Moorthy et al[21]	2004	Da Vinci	10 surgeons of varying experience Lab based suturing task	Time and distance travelled of instruments in 2D and 3D Significant difference in both in 3D	NA
Badani et al[22]	2005	Da Vinci	7 surgeons (3 experienced with Da Vinci, 4 not) 2 × lab based suturing tasks	Time and errors Significant difference in 3D in all areas	NA
Blavier et al[23]	2007	Da Vinci	40 medical students Lab based skills task	Errors, performance and learning curve Significant difference in 3D	No detrimental symptoms reported
Byrn et al[24]	2007	Da Vinci	12 surgeons of varying experience 4 × lab based skills tasks	Time and errors in 2D and 3D Significant difference in 3D	No detrimental symptoms reported
Blavier et al[25]	2007	Da Vinci	60 medical students 4 × lab based skills task (increasing difficulty)	Specific performance metric score Significant difference in 3D in all tasks	No detrimental symptoms reported
Fishman et al[27]	2008	Da Vinci and prototype Ames stereoscopic camera	12 subjects of varying exposure to stereoptic systems	Time for completion while altering binocular disparity of stereoptic camera until 0% (matching 2D vision)	NA
Blavier et al[28]	2009	Da Vinci	Lab based skills task using Da Vinci manipulator 80 subjects (60 novice individuals and 20 expert laparoscopic surgeons) Lab based task	Significant difference with 3D from binocular disparity Time for task completion and estimation of time in 2D or 3D not both Significant difference in 3D for novices, similar results for experts	NA

NA: Not available; 3D: Three-dimensional; 2D: Two-dimensional.

Table 3 Dual channel laparoscopes - Screen projection and glasses

Ref.	Year	Projection system for 3D	Who and what assessed	Objective outcomes	Subjective outcomes
Birkett et al[26]	1994	Active shuttering screen and Active glasses then polarised glasses vs 2D	10 Subjects? experience 2 × lab based skills tasks	Time take for repetitive cycles; No difference in simples task, reduced time in complex task	NA
Peitgen et al[29]	1996	Active shuttering screen and glasses	60 subjects (20 novices, 20 beginners, 20 advanced laparoscopic surgeons) 2 × lab based skills tasks	Time and accuracy of tasks Both significantly improved in 3D, independent of experience	NA
Wentink et al[30]	2002	Active shuttering screen and polarised glasses vs TFT display vs projection vs standard (2D)	8 surgeons with laparoscopic experience Lab based skills task	Time for task completion, 10 repetitions but only 2 surgeons per visual system No improvement with 3D	Felt image quality poorer with 3D
Jourdan et al[31]	2004	Active shuttering screen and glasses	8 experienced laparoscopic surgeons 5 × lab based skills tasks	Time and errors, 10 repetitions each, in each visual system Significant improvement in both in 3D	NA
Feng et al[32]	2010	Active shuttering screen and polarised glasses (SD vs 2D SD vs 2D HD)	27 subjects (16 novices, 11 with varying laparoscopic experience) Lab based skills task	Time and economy of movement Time significantly improved over both 2D systems in 3D, economy of movement improved in 3D vs HD, not SD 2D	Felt improved depth perception in 3D
Hubber et al[33]	2003	Prototype passive polarising screen and glasses	16 Medical Students (novices) Lab based skills tasks	Time and performance (ICSAD) Improvements in 3D significant over 2D	NA
Honeck et al[34]	2012	Passive polarising screen and glassed	10 novices and 10 experienced laparoscopic surgeons 5 × lab based skills tasks	Time and errors (1 × repetition, in only 1 of the visual systems) No significant improvement in time, reduction in errors significant in both groups in 3D	No impairment felt in subjective feedback when using the 3D system
Smith et al[35]	2012	Passive polarising screen and glassed	20 novices 4 × lab based skills tasks	Time and errors (10 repetitions of each task in each visual condition) Significant improvement in time and errors in 3D	NA
Bilgen et al[36]	2013	Passive polarising screen and glassed	3 surgeons Clinical - 11 laparoscopic cholecystectomies performed in 3D (compared to 11 performed retrospectively in 2D)	Time Significant reduction in time when performed in 3D, compared to case matched lap choles performed previously in 2D	NA
Sinha et al[37]	2013	Passive polarising screen and glassed	Retrospective analysis of 451 clinical gynaecological surgery performed in 3D Case matched assessment of 200 hysterectomies performed in 3D vs 2D	Time Significant reduction in operating time and morcellation time when performed in 3D	NA
Cicione et al[38]	2013	Passive polarising screen and glassed	33 subjects (10 experts and 23 novices) 5 × lab based skills tasks (Basic Laparoscopic Urological Skills)	Time and errors Overall, significant improvement in time and errors (although experts only improved time in 1 task in 3D)	Subjective Questionnaire - felt tasks were easier in 3D universally
Lusch et al[39]	2014	Passive polarising screen and glassed	24 subjects (10 medical students, 7 residents, 7 expert surgeons) 6 × lab based skills tasks	Time and errors 4 out of 5 skills tasks had significantly improved time and errors when done in 3D, independent on experience	Optical resolution and depth perception improved in 3D
Smith et al[40]	2014	Passive polarising screen and glassed	20 experienced surgeons 4 × lab based skills tasks	Time and errors (10 repetitions of each task in each visual condition) Significant improvement in time and errors in 3D	Subjective assessments using NASA Task Load Index - improvements with 3D all sections

NA: Not available; 3D: Three-dimensional; 2D: Two-dimensional; HMD: Head mounted display.

Table 4 Comparing multisystems

Ref.	Year	Projection system for 3D	Who and what assessed	Objective outcomes	Subjective outcomes
van Bergen et al[41]	1998	2 × single channelled and 2 × dual channelled scopes + active shuttering screen vs 2D	40 subjects - novices Variety of different models and skills tasks	Times and errors Objectively - significant improvement in 3D throughout	Subjectively - all tasks judged easier in 3D
Hanna et al[42]	2000	Single-channel scope + active shuttering screen and glasses; double-channel scope + active	10 experienced surgeons Lab based endoscopic anastomotic suturing	Time, precision of suture placement and pressure leakage score of anastomosis (2 × repetitions in each visual system) 3D systems evaluated together, no significant difference noted in 3D	Visual strain reported with 3D systems
Wilhelm et al[43]	2014	Dual channel scope + passive polarising screen and glasses vs 2D vs autostereoscopic screen	48 subjects, varying experience Lab based suturing task	Time, economy of movement (electromagnetic tracking) and workload assessments (using NASA Task Index Score All performance parameters were superior in 3D	No symptoms in 3D PP system, visual disturbance reported with autostereoscopic display
Wagner et al[44]	2012	Single-channel scope + HMD vs robotic dual channel scope + fixed head view	34 subjects (18 novices) 3 × lab based skills tasks	Time 3D robotic performance faster than all others, significantly	NA

NA: Not available; 3D: Three-dimensional; 2D: Two-dimensional; HMD: Head mounted display.

Table 5 Other prototype projection systems

Ref.	Year	Projection system for 3D	Who and what assessed	Objective outcomes	Subjective outcomes
Taffinder et al[45]	1999	Dual channel scope with autostereoscopic/glass free screen	28 subjects (16 novices and 12 experienced laparoscopic surgeons) Novices = basic grasping and cutting lab based skills Experienced = suturing and complex cutting lab based skills	Time and performance score (ICSAD assessment tool) Significant improvement in 3D over 2D laparoscopy	No side effects reported with 3D
Ohuchida et al[46]	2009	Dual channel scope with “Cyberdome” projection system	23 novices 6 × lab based skills tasks	Time, errors and performance Significant improvement in all parameters in 3D with cyberdome over 2D	NA
Storz et al[47]	2011	Dual-channel scope + wavelength multiplex camera and monitor with polarising glasses	30 subjects (20 medical students and 10 experienced laparoscopic surgeons) 5 × lab based skills tasks	Time and errors In 4 out 5 tasks, significant reduction in time in 3D, in 4out of 5 tasks, significant reduction in errors	NA
Khoshabeh et al[48]	2012	Dual-channel scope + Multiview autostereoscopic display/glass free screen	3 experienced laparoscopic surgeons 2 × lab based skills tasks	Time and errors Reduced time and errors using 3D	NA

NA: Not available; 3D: Three-dimensional; 2D: Two-dimensional.