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. 2022 Jan 17:8:792107.
doi: 10.3389/fsurg.2021.792107. eCollection 2021.

Must Clinics Replace 2D by 3D Environments for an Efficient Training of Laparoscopic Novices? A Critical Analysis of the Learning Curve for Basic Skills

Maik Sahm  1   2 , Clara Danzer  1 , Alexis Leonhard Grimm  1 , Christian Herrmann  1 , Rene Mantke  1
Affiliations

Must Clinics Replace 2D by 3D Environments for an Efficient Training of Laparoscopic Novices? A Critical Analysis of the Learning Curve for Basic Skills

Maik Sahm et al. Front Surg. .

Abstract

Background and aims: Published studies repeatedly demonstrate an advantage of three-dimensional (3D) laparoscopic surgery over two-dimensional (2D) systems but with quite heterogeneous results. This raises the question whether clinics must replace 2D technologies to ensure effective training of future surgeons.

Methods: We recruited 45 students with no experience in laparoscopic surgery and comparable characteristics in terms of vision and frequency of video game usage. The students were randomly allocated to 3D (n = 23) or 2D (n = 22) groups and performed 10 runs of a laparoscopic "peg transfer" task in the Luebeck Toolbox. A repeated-measures ANOVA for operation times and a generalized linear mixed model for error rates were calculated. The main effects of laparoscopic condition and run, as well as the interaction term between the two, were examined.

Results: No statistically significant differences in operation times and error rates were observed between 2D and 3D groups (p = 0.10 and p = 0.72, respectively). The learning curve showed a significant reduction in operation time and error rates (both p's < 0.001). No significant interactions between group and run were detected (operation time: p = 0.342, error rates: p = 0.83). With respect to both endpoints studied, the learning curves reached their plateau at the 7th run.

Conclusion: The result of our study with laparoscopic novices revealed no significant difference between 2D and 3D technology with respect to performance time and the error rate in a simple standardized test. In the future, surgeons may thus still be trained in both techniques.

Keywords: 2D laparoscopy; 3D laparoscopy; learning curve; novice; surgical skill.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A practice module “Pack your luggage” of the Luebeck Toolbox: Open-box and sorting sleeves according to color.
Figure 2
Figure 2
Mean operating time and 95% confidence bands.
Figure 3
Figure 3
A density plot of error rates.
Figure 4
Figure 4
Comparison between two-dimensional (2D) and three-dimensional (3D) systems regarding technical errors.
See this image and copyright information in PMC

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