Basic Laparoscopic Skills Training Is Equally Effective Using 2D Compared to 3D Visualization: A Randomized Controlled Trial

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.

Keywords: Fundamentals of Laparoscopic Skills (FLS); basic laparoscopic skills (BLS); depth perception; laparoscopy; three-dimensional visualization; training; two-dimensional visualization.

Figure 1

Peg transfer task score development over the four training sessions. The mean time for task completion in seconds is shown for each repetition of the peg transfer task at each training session. The red line represents the values for the participants of the 3D group and the blue one, those for the participants of the 2D group. The vertical lines mark the first repetition at each training session. On the x-axis, the training session and the respective repetition number are noted (for example, “1_1” means training session 1, repetition number 1).