We present a user performance analysis of four navigation systems based on different visualization schemes (2D, 3D, stereoscopy on a monitor, and a stereo head mounted display (HMD)). We developed a well-defined user workflow, which starts with the selection of a safe and efficient needle path, followed by the placement, insertion and removal of the needle. We performed the needle procedure on a foam-based phantom, targeting a virtual lesion while avoiding virtual critical structures. The phantom and needle"s position and orientation were optically tracked in real-time. 28 users performed each a total of 20 needle placements, on five phantom configurations using the four visualization schemes. Based on digital measurements, and on qualitative user surveys, we computed the following parameters: accuracy and duration of the procedure, user progress, efficiency, confidence, and judgment. The results show that all systems are about equivalent when it comes to reaching the center of the target. However the HMD- and 2D- based systems performed better in avoiding the surrounding structures. The needle procedures were performed in a shorter amount of time using the HMD- and 3D- based systems. With appropriate user training, procedure time for the 2D- based system decreased significantly.