The Effect of Three-dimensional Versus Two-dimensional Imaging Displays On Task Performance by Laparoscopy-naive Subjects

Joseph M Drosdeck, MD, David B Renton, MD. The Ohio State University Wexner Medical Center.

Introduction: Inanimate laparoscopic training techniques such as the Fundamentals of Laparoscopic Surgery (FLS) have a proven benefit on operative skills in trainees with little to no laparoscopic experience. In conjunction with these training techniques, three-dimensional (3D) imaging provides an added benefit to novice trainees with laparoscopic experience. However, the utility of 3D imaging with FLS based tasks in laparoscopy-naïve trainees is unclear. We aim to investigate the role of 3D imaging in laparoscopy-naïve participants using two FLS based tasks. We hypothesize that participants who utilize 3D imaging during these tasks will perform better than participants who utilize two-dimensional (2D) imaging.

Methods and Procedures: First through fourth year medical students at The Ohio State University were recruited. Participants were randomized to either 3D or 2D imaging prior to performing two FLS tasks – peg transfer and circle cut. For each task, time to completion and number of errors were recorded. A numerical global performance score was calculated for each participant on each task, where higher scores indicate better performance. Scores accounted for time to completion and number of errors committed. A non-parametric test, Wilcoxon Rank Sum Test, was used to draw inferences between experimental groups on peg transfer time, peg transfer score, circle cut time, and circle cut score. Fisher’s Exact Test was employed to draw inferences between experimental groups on peg transfer errors and circle cut errors.

Results: Seventy-nine medical students participated; 39 students were randomized to the 3D group and 40 were randomized to the 2D group. The median peg transfer time was significantly shorter in the 2D group (270 seconds vs. 325 seconds), p = 0.033, and the median peg transfer score was significantly higher in the 2D group (330 vs. -25), p = 0.032. Peg transfer errors did not differ significantly between groups (p = 0.41). Circle cut time, errors, and score did not differ significantly between groups, p = 0.43, 0.65, 0.91, respectively.

Conclusions: Laparoscopy-naïve participants in the 3D group performed similarly to participants in the 2D group on the circle cut task and worse than participants in the 2D group on the peg transfer task. These findings suggest that educators may wish to avoid 3D imaging in laparoscopy-naïve trainees during inanimate laparoscopic training tasks.

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