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Comparison of three-dimensional and two-dimensional laparoscopic video systems.

The limitations of two-dimensional (2D) video may be overcome by the recent introduction of the three-dimensional (3D) laparoscope and video system. Twenty-two urologic and gynecologic surgeons experienced in laparoscopy were evaluated during a live porcine laboratory session in an advanced course designed to teach laparoscopic retroperitioneal nephrectomy and bladder neck suspension. The surgeons performed dissection of the kidney, securing of the renal vessels, laparoscopic suturing and intracorporeal knot-tying at the bladder neck, and suture clipping of an intracorporeally placed suture at the bladder neck using 2D and 3D equipment. The time needed to complete each technique was recorded and compared using nonparametric analysis. The participants' subjective evaluation of the 3D system was also analyzed. Three-dimensional video did not significantly improve the surgeons' ability to perform laparoscopic dissection of the kidney, securing the renal vessels, or laparoscopic suturing and knot-tying. Surgeons felt that the 3D system did not improve vision or perceived surgical performance sufficiently to justify an expense greater than that of the 2D systems now available. Compared with the standard 2D camera system, the currently available 3D video system does not hasten the laparoscopic dissection of tissues or the performance of advanced technical maneuvers such as laparoscopic suturing and knot-tying by experienced laparoscopists.