Imaging for endoscopic surgery: new developments applicable to pediatric surgical interventions.

To introduce pediatric surgeons to new developments in imaging that are already or soon to become available that permit "in-line" work and three-dimensionality, five new approaches to imaging were evaluated in 419 children over a 3-year period: (1) Image projection onto the abdomen (n = 4). As opposed to conventional video camera positions, with this modality the line of view and the line of work are aligned. (2) Image projection onto a plate mounted just above the abdomen (n = 280). As in the first approach, screen arrangement position obviates looking up at the monitor. (3) A touch screen mounted above the abdomen, enabling the surgeon to not only monitor the procedure, but also to control all the equipment (n = 128). As with the first two modalities, the line of view is aligned with the direction of the work. (4) A three-dimensional (3-D) head display (n = 6). With this approach the use of a headset is required. (5) A 3-D screen (n = 1) for which, no goggles or headsets are required. The 3-D picture can be appreciated from a wide angle of view, and thus can be used by the surgeon and assisting team. Direct imaging projection onto the abdominal surface is a visual process that at present is too complicated for routine surgery. Projection onto a flat plate or touch screen is a major improvement; the surgeon looks and works in the same direction. Headsets for 3-D imaging remain heavy and the image is not as sharp as that provided by two-dimensional monitors. The most significant practical progress was felt to be with the flat 3-D monitor because with this equipment, depth perception and ergonomic positioning were both rated as very good. New imaging modalities are exciting, albeit still in their early developmental stages. The novel imaging provided by a 3-D monitor is most promising, because it combines good depth perception with physiologic in-line visual-manual coordination. These developments should further facilitate the transition from conventional, open techniques to videoscopic approaches.