Despite well-established advantages of minimally invasive surgery, laparoscopy lacks of natural stereoscopic depth perception and spatial orientation. Therefore, these 2 parameters appear to represent mayor downsides of minimal-invasive surgery. Still, the importance and overall negative effect of this lack of natural stereoscopic depth perception and spatial orientation has not been clearly demonstrated. The aim of this study was to evaluate if three-dimensional (3D) visualization improves surgical skills and task performance when compared to two-dimensional (2D) vision.
Material and Methods
Difference between 3D and 2D vision was tested in 34 individuals of different surgical levels (n=4: more than 10years surgical experience, n=8: 5-10y.; n=9:1-5y; n=13: no hands-on professional experience).
Each individual performed three different tasks (T1-3) in an open, laparoscopic and robotic surgical technique T1 intended to test three dimensional imaging and spatial relationships by using small rubber rings which had to be placed over soft cones for training simple grasping and positioning. T2 tested dexterity and precision using a suture that had to be passed from instrument hand to hand through 10 flexible small eyelets arranged in an S curve. T3 tested dexterity in suturing and knot tying of a simulated gaping skin incision. Each task was performed in a 3D mode using binocular vision for open performance, the Viking 3Di Vision System for 3D laparoscopic performance and the daVinci system in a 3D mode for robotic performance. Subsequently same tasks were repeated in a 2D mode respectively (open monocular by means of a blindfold, conventional laparoscopy, daVinci 2D mode). Times of each performance was taken and statistically evaluated.
Loss of 3D vision increased difficulty and time to perform a task independent of the approach. To solve simple tasks in 2D vision it took about 25% longer than in 3D vision. For more complex tasks 2D vision prolonged the procedure by about 75%. For easy tasks laparoscopic and robotic assisted performance were similar with a trend towards shorter time for performance with the robotic system. For harder tasks performed under 3D vision, robotic-assisted performance was faster than laparoscopic performance. 3D robotic-assisted performance was superior to 2D laparoscopic performance, independent of the difficulty of the task.
The percentage of time reduction by 3D to perform a task was dependent on the difficulty of the task and independent of the modality. The more complex a task, the more 3D vision increased performance compared to 2D vision.
Open approach was superior to laparoscopic or robotic-assisted procedures, independent of the task or vision. For harder than easy tasks performed under 3D vision, robotic-assisted performance is faster than laparoscopic performance. Performance under 2D vision is not significantly different between laparoscopy and robotic-assisted procedures, independent of the difficulty of the task. The importance of vision does not rectify to directly compare laparoscopic surgery with robotic-assisted surgery. The main difference between task performance in laparoscopy and robotic-assisted surgery seems to be the vision!
Program Number: P495