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Br J Surg. 2017 Jul;104(8):1097-1106. doi: 10.1002/bjs.10528. Epub 2017 Apr 20.

Impact of simulated three-dimensional perception on precision of depth judgements, technical performance and perceived workload in laparoscopy.

Author information

Schools of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
Schools of Psychology, The University of Queensland, Brisbane, Queensland, Australia.



This study compared precision of depth judgements, technical performance and workload using two-dimensional (2D) and three-dimensional (3D) laparoscopic displays across different viewing distances. It also compared the accuracy of 3D displays with natural viewing, along with the relationship between stereoacuity and 3D laparoscopic performance.


A counterbalanced within-subjects design with random assignment to testing sequences was used. The system could display 2D or 3D images with the same set-up. A Howard-Dolman apparatus assessed precision of depth judgements, and three laparoscopic tasks (peg transfer, navigation in space and suturing) assessed performance (time to completion). Participants completed tasks in all combinations of two viewing modes (2D, 3D) and two viewing distances (1 m, 3 m). Other measures administered included the National Aeronautics and Space Administration Task Load Index (perceived workload) and the Randot® Stereotest (stereoacuity).


Depth judgements were 6·2 times as precise at 1 m and 3·0 times as precise at 3 m using 3D versus 2D displays (P < 0·001). Participants performed all laparoscopic tasks faster in 3D at both 1 and 3 m (P < 0.001), with mean completion times up to 64 per cent shorter for 3D versus 2D displays. Workload was lower for 3D displays (up to 34 per cent) than for 2D displays at both viewing distances (P < 0·001). Greater viewing distance inhibited performance for two laparoscopic tasks, and increased perceived workload for all three (P < 0·001). Higher stereoacuity was associated with shorter completion times for the navigating in space task performed in 3D at 1 m (r = - 0·40, P = 0·001).


3D displays offer large improvements over 2D displays in precision of depth judgements, technical performance and perceived workload.

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