Distraction and proficiency in laparoscopy: 2D versus robotic console 3D immersion

Introduction: Studies have shown that using robotic-assisted laparoscopy (RL) increases performance compared to conventional laparoscopy (CL) due to its mechanical advantages but have not assessed distraction as a factor. To determine whether the immersive aspect of the 3D optics in RL contributes to improved performance, we compared the outcomes of laparoscopic skills by using just the 3D optics of the da Vinci versus the conventional 2D monitor with and without distraction.

Methods: Thirty-two participants without any laparoscopic experience were randomized evenly into four groups: RL, robotic-assisted laparoscopy with distraction (RL + D), CL, and conventional laparoscopy with distraction (CL + D). Each participant performed three Fundamentals of Laparoscopy Surgery tasks [peg transfer (Task 1), circle cutting (Task 2), and suturing with knot (Task 3)] for three repetitions. For each task, the mean time and errors were recorded and analyzed statistically for each group.

Results: Compared to other groups, CL + D took on average 1 min longer to complete Task 1 (P = 0.001), more than 1 min to complete Task 2 (P = 0.003), and more than 2 min to complete the Task 3 (P < 0.001). On Task 2, the deviations from the pattern were shorter for RL and RL + D compared to CL and CL + D (mean 0.33 and 0.37 cm vs. 0.55 and 0.58 cm, respectively; P < 0.001). On Task 3, the deviations were also shorter for RL and RL + D compared to CL and CL + D (mean 0.23 and 0.24 mm vs. 0.61 and 0.63 mm, respectively; P < 0.001).

Conclusion: When distraction was introduced, CL performed significantly worse. This suggests that using the conventional 2D monitor does not help with blocking out distraction. For Tasks 2 and 3, which require more precision and depth perception, the groups that used the 3D optics had shorter mean deviations than groups that used the conventional 2D monitor. This suggests that even when the robotic arms of the da Vinci are removed, there are still advantages to the immersive 3D optics, especially when distraction is present. The immersive aspect of the 3D optics may help improve performance in the OR, allowing surgeons to be more focused on the case and have greater depth acuity.