Video-assisted technology for minimally invasive surgery uses the coaxial approach (working field between surgeon and video monitor). Complex procedures and two-team approaches disrupt this relationship causing paradoxic motion. In an effort to obviate these issues, a head-mounted monitor display has been used by the surgeon in 74 of these complex operative procedures. The head-mounted display (HMD) eliminates the negative effects of yaw, roll, and pitch - each of which is detrimental to the performance of complex operative procedures. There has been no visual strain or ocular fatigue observed. In contrast, the HMD allowed increased concentration without subjective muscle strain for as long as 640 mins. The authors conclude that the HMD improves efficiency in complex procedures, increases safety, diminishes cost, and allows optimum visualization of the operative field by the surgeon and assistants in congested operating-room environments.