Abstract
Reduced depth perception due to two-dimensional (2D) visualization of a three-dimensional (3D) space represents a main challenge in acquiring basic laparoscopic skills (BLS); 3D visualization might increase training efficiency. This study aimed to assess whether BLS training on a standard box trainer using 2D is at least equally effective compared to 3D. Medical students were randomized to training of Fundamentals of Laparoscopic Surgery (FLS) tasks using either 2D or 3D for four weeks. Baseline and post-training tests were performed using the assigned visualization modality. Data of 31 participants were analyzed (n = 16 2D, n = 15 3D). Baseline test scores did not differ significantly between groups; only at the peg transfer task and total scores, the 3D group performed better than the 2D group. All scores improved significantly in both groups, with post training scores not differing significantly between groups. Non-inferiority of 2D compared to 3D was demonstrated for total score improvement and improvement in all individual FLS tasks except for suturing with extracorporeal knot tying. Post training test performance did not change significantly when changing to the unfamiliar modality. In conclusion, BLS training using standard 2D is at least equally effective as with 3D, without significant disadvantages when changing to the other modality.
Highlights
Due to its numerous advantages compared to laparotomy, laparoscopy has become the standard operative technique for an increasing number of surgical procedures [1]
Reduced operation time using 3D compared to 2D was seen for other surgical procedures such as total laparoscopic hysterectomy, for which a retrospective study analyzing hysterectomies for large uteri over 500 g found a reduced total operative time, and lower blood loss and complication rates in the 3D compared to the 2D group [7]
The aim of this study was to investigate whether practicing on a standard laparoscopic box trainer using 2D visualization is at least effective compared to 3D in terms of basic laparoscopic skills (BLS) improvement, by means of a randomized controlled trial with last-generation 3D equipment, selected participants with limited laparoscopic experience, and using standardized and validated tasks
Summary
Due to its numerous advantages compared to laparotomy, laparoscopy has become the standard operative technique for an increasing number of surgical procedures [1]. Compared to open surgery, laparoscopy is more difficult to learn [2] It requires specific psychomotor skills and surgeons have to work in a three-dimensional (3D) space using two-dimensional (2D) imaging, which leads to reduced depth perception [3]. More recent studies using third-generation 3D equipment show improved performance and a reduction in surgical time and errors [4,5]. This seems to be true especially for more complex surgical procedures. Reduced operation time using 3D compared to 2D was seen for other surgical procedures such as total laparoscopic hysterectomy, for which a retrospective study analyzing hysterectomies for large uteri over 500 g found a reduced total operative time, and lower blood loss and complication rates in the 3D compared to the 2D group [7]
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