Video-assisted surgery represents more than a loss of three-dimensional vision.

Background: Loss of depth cues is a major challenge facing surgeons performing video-assisted surgery (VAS). Whether the degradation of image quality from a video-displayed image plays a direct role in performance of VAS has not been studied.

Methods: Twenty-four volunteer novice subjects were randomized to binocular direct-vision (BDV), monocular direct-vision (MDV), or video-imaging (VI) conditions. Each subject completed ten trials of a simple cutting task in a box trainer using standard laparoscopic instruments.

Results: VI subjects made significantly fewer correct incisions than both of the other groups for all trials. Differences between the BDV and MDV groups did not reach statistical significance. Improvement in performance was more rapid in the BDV group than in either the MDV or VI groups.

Conclusions: The degradation of image quality with VI has a detrimental influence on VAS performance above and beyond the loss of binocular vision.