Evaluation of 3-D Laparoscopy to Complete Surgical Skills Tasks

Marc Singer, MD, Jill Endres, MD, Amy Yetasook, BA, Wissam Halabi, MD, Igor Voskresensky, MD, Michael J Stamos, MD, Ronald Clements, MD

NorthShore University HealthSystem, University of California – Irvine, Vanderbilt University

INTRODUCTION

The benefits of 3-D imaging during complex laparoscopic procedures are not known. The enhanced visual perception potentially improves surgeons’ speed, accuracy, and precision in the operating room. The objective of this study was to compare the performance of inanimate surgical tasks using conventional 2-D imaging and 3-D imaging.

METHODS

A prospective trial was conducted at three facilities, and IRB approval of the protocol was obtained at each site. 24 subjects (12 experienced laparoscopic surgeons and 12 senior residents/fellows) were enrolled. Each subject performed 4 tasks: grasping beads, suturing a rubber membrane, dissecting along a line, and pointing through eyelets. Each task was performed using 2-D and 3-D imaging, and the sequence was repeated 5 times. The subjects were randomly assigned to start with 2-D or 3-D, and data from only the last three sequences were recorded to minimize the influence of the “learning curve.” A prototype system that readily switches between 2-D and 3-D (Olympus LTF-Y0009, Olympus Medical Systems Corp, Tokyo, Japan) was used. All trials were recorded, and an outsourced third party consultant, blinded to the method of imaging, assessed completion times and errors. Errors were assessed according to predefined criteria. For each task, the performance time and number of errors were analyzed as a function of imaging mode (2-D vs. 3-D), surgeon experience (attending vs. resident/fellow), and operative distance from the camera (4cm vs. 9 cm). Time data was analyzed with a general linear model and error data analyzed with a generalized estimating equation with Poisson distribution and Pearson Chi square correlation.

RESULTS

3-D imaging resulted in faster completion times for bead transfer (0:29 vs. 0:24 seconds, p<0.001), suturing (4:35 vs. 3:26 minutes, p<0.001), dissecting (2:49 vs. 2:36 minutes, p=0.042), and pointing (0:16 vs. 0:14 seconds, p<0.001). 3-D imaging also resulted in fewer errors (26.77 vs. 15.04, p<0.001) and reduced variance (114.01 vs. 55.36, p=0.015) for bead transfer, but not suturing, dissecting, or pointing. There were no differences in completion time or number of errors based on surgeon experience or position of the model from the camera.

CONCLUSIONS

3-D imaging enhanced speed while performing all 4 laparoscopic surgical tasks. Accuracy and precision were improved for bead transfer. The benefits of 3-D imaging were maintained across levels of surgeon experience and over a range of operative fields. Correlation to clinical outcomes is necessary to further evaluate the value of this technology.

Session: Poster Presentation

Program Number: P520