Does the ability to view three-dimensional images on an OR's monitors make a difference in surgical outcomes? As far as clinical evidence is concerned, the jury is still out. According to physicians who use 3D imaging technology, however, the impact is huge. Here are 3 improvements 3D brings to surgery.

1. Confident and convinced surgeons
Surgeons say depth perception lets them see the surgical site in greater detail and with higher acuity, which holds the potential of improved technique. A laparoscope designed with 2 independent camera systems that captures slightly angled images to approximate human binocular vision delivers what Robert Owens, MD, an otolaryngologist at the Owens Ear Center in Dallas, Texas, describes as "more immersive visualization" for surgery.

The visual effect is completed through the simultaneous presentation of the 2 images on a display monitor, images that the viewer's brain assembles into one when looking at the screen through a set of polarized lenses.

Consider a physician tackling a radical prostatectomy. The procedure is increasingly performed with a surgical robot, but traditional laparoscopic tools provide more tactile feedback, a factor in sparing the site's delicate neural network. The 3D imaging practically takes the surgeon into the site.

"For a complex operation like that, to take steps to preserve the nerves is no small thing," says Gerald Andriole, MD, the Robert Killian Royce Distinguished Professor of Surgery and chief of the urologic surgery division at Washington University of St. Louis (Mo.) School of Medicine. "Anecdotally, 3D surgery is quicker and better, too."

2. Ergonomic advantages
Some 3D imaging systems attach a camera to the oculars of a surgical microscope to deliver its stereoscopic view to a high-definition monitor. As a result, the depth perception once available only through a microscope can now be viewed in real time on a boom- or wall-mounted display, letting the surgeon operate in a heads-up procedure instead of stooping to the microscope's optics repeatedly or for long periods of time.

"I don't think you 're going to find it said anywhere that 3D has been proven to improve technique," says Dr. Owens, "but it definitely offers some improvements if you're operating all day long."

As with 3D laparoscopy, you'll need to wear sunglass-like polarized lenses to view the end result. "Good 3D needs glasses," says Nathan Pinkney, senior project engineer for the ECRI Institute, a non-profit healthcare research organization in Plymouth Meeting, Pa. "If you don't have to wear glasses, it's not true 3D," since the illusion of depth will be created by some form of image manipulation on the display monitor rather than by a binocular vision effect. "Then your resolution will suffer," he warns.

3. Shared view and efficiency
Advances in 3D imaging technology now let all surgical staff get the picture and get on board with the potential efficiency it offers.

While the visual effect requires glasses to view, it's a relatively lightweight accessory to wear in comparison with previous versions of the technology. Earlier users had to wear helmets or head-mounted displays, a bulky solution that weighed the surgeon down and risked getting in the way of surgical technique, says Dr. Andriole.

Given its expense, previous generations of 3D technology also limited who in the OR could see the images. The glasses, on the other hand, are inexpensive enough that the entire team can be equipped for 3D viewing. That benefits surgical efficiency and preparation, says Dr. Owens.

"If you don't have the perception of depth, you don't know with certainty what's going on," he says. "You can't tell how deep the surgeon is working, how far into the surgical site he is or how close he is to the end."

If the assistant at a surgical microscope's teaching head, which only offers a 2D view, and the nurses and techs, who have a 2D view on the monitor if they have any view at all, share the surgeon's 3D visualization, "it helps put everybody on the same page in the OR," says Dr. Owens. "They can anticipate the next move and what instruments the surgeon needs next. It increases efficiency and decreases surgical time if everybody is seeing what he sees."