Original article The benfits of stereoscopic vision in robotic-assisted performance on bench models Y. Munz 1 , K. Moorthy 1 , A. Dosis 1 , J. D. Hernandez 1 , S. Bann 1 , F. Bello 1 , S. Martin 1 , A. Darzi 1 and T. Rockall 1 Received: 20 January 2003 Accepted: 22 August 2003 Published online: 2 February 2004 Abstract Background: Previous studies have failed to establish clear advantages for the use of stereoscopic visualization systems in minimal-access surgery. The aim of this study was to objectively assess whether stereoscopic visualization improves performance on bench models using the da Vinci robotic system. Methods: Eleven surgeons carried out a series of four tasks. Positional data streamed from the da Vinci system was analyzed by means of a previously validated custom-designed software-package. An independent blinded observer scored errors. Statistical analysis included the Wilcoxon signed rank test. A p < 0.05 was deemed significant. Results: We found significant improvements in all tasks and for all parameters (p < 0.05). In addition, a significantly lower number of errors was scored using the stereoscopic mode as compared to the standard two-dimensional image (p < 0.001). Conclusion: Robotic-assisted performance on bench models is more efficient and accurate using stereoscopic visualization. Keywords Robotics - Laparoscopy - Three-dimensional visualization - Surgical performance During the last 2 decades, robotic systems have evolved from simple instrument stabilizers, through voice- controlled camera stabilizers (AESOP; Computer Motion, CA, USA), to more comprehensive solutions, such as telemanipulator systems (Zeus and de Vinci [Intuitive Surgical, Mountain view, CA, USA]). At the same time, visualization technologies followed a similar path of evolution, with the ultimate aim of restoring the surgeon s stereoscopic vision. The application of stereoscopic visualization systems in laparoscopic surgery has gone through several stages of development since the early 1990s [18 , 19 ]. The first generation of stereoscopic vision systems, which consisted of two separate video cameras attached to a single optical channel (standard endoscope) that alternately transmitted signals to a head-mounted device, produced sufficient stereoscopic visualization. However, these systems did not find much favor with the surgical community because they were ergonomically unsuitable. Moreover, they were associated with neurophysiological side effects that were attributed mainly to the optical shuttering, which caused ocular fatigue, headaches, and nausea [4 , 9 , 13 , 17 ]. The next generation of stereoscopic vision systems relied on the same basic principle. However, the images were displayed on a monitor, while the surgeon wore simple lightweight polarizing glasses, so that each eye received only a single respective signal. The right and left signals then fused in the visual cortex to produce a three-dimensional (3D) image. Although several studies have demonstrated the advantages of 3D systems [3 , 16 ], others have suggested that the benefit is negligible. This lack of proven efficacy, together with the Surgical Endoscopy © Springer-Verlag 2004 10.1007/s00464-003-9017-9 (1) Department of Surgical Oncology and Technology, Imperial College London, St. Mary s Hospital, London, England, United Kingdom Y. Munz Email: yaron.munz@ic.ac.uk Page 1 of 10 10.1007/s00464-003-9017-9 9/4/2004 http://www.springerlink.com.osiyou.cc.columbia.edu:2048/media/6p8qdgxyrn1tlcuq9evl/Contributions/...