Quantitative Comparison between the Heads-up-display (HUD) and Common Monitor in Endoscopic Surgery Enrico Marchese*, M.D., Abhilash Pandya, M.S., Mohammad Mahmoud, M.D., Michael Higgins, M.D., Qinghang Li, M.D., Ph.D., Lucia Zamorano, M.D. *Department of Neurosurgery, Catholic University, Rome, Italy Department of Neurological Surgery, Wayne State University, Detroit, Usa Introduction: The use of heads-up display (HUD) in endoscopic neurosurgical procedures was previously described in the literature. But there were no studies reporting an objective evaluation of HUD use. In this study, we developed an experimental model to assess the real impact of HUD on the performance of the endoscopic procedure. Results: Fifteen subjects participated in the test. The average time and errors to perform the test was: HUD 194 sec-6.06 errors; monitor at 0 224 sec-8.33 errors; monitor angled at 45 234 sec-8.46 errors (Table 1,2). Statistically significant results (p=0.016 and p=0.014) were found matching both time and error data of the HUD with those of the monitor angled at 45 (Table 3). Methods: The purpose of the test was to pick up six small objects from six tiny cavities located on the bottom of a closed box using a 0 rigid endoscope and biopsy forceps. An electrical plate surrounding the cavity’s edges registered any contact with the endoscope or with the forceps. The test was formed in three different parts: in the first the TV monitor was located in front of the subject (0), in the second the monitor was angled at 45 and in the third a HUD (800 x 600 pixel resolution) was used. To assure the data were free of a "learning curve" bias, the three trials were sequenced randomly. Conclusions: The results obtained in this study, especially those regarding the use of HUD compared with a 45 angled monitor, confirm that HUD influences positively the performance of the endoscopic procedure.