Comparison of operative skill using two-and three-dimensional monitor during laparoscopic phantom tasks by the position tracker

BACKGROUND: The recent development of stereoscopic images using three‐dimensional (3D) monitors is expected to improve techniques for laparoscopic surgery. There are few reports that analyze forceps motions by 3D optical tracking systems during laparoscopic phantom tasks. Thus, we attempted to develop a 3D motion analysis system for assessing laparoscopic tasks, and to clarify the efficacy of using stereoscopic images from a 3D monitor to track forceps movement during laparoscopic surgery. METHODS: Twenty moderately experienced surgeons performed three tasks (task 1: a simple operation by the dominant hand, task 2: a simple operation by both hands, task 3: a complicated operation by both hands) under 2D and 3D monitor. After randomization, the participants were divided into 2 groups, one started by doing a complete set of tasks under 2D vision, and the other started under 3D vision. Then, each group performed the same set of tasks again using changed vision. The participants performed each task 5 times, and their performances were recorded by a position tracker in order to analyze the forceps' motion. We compared operative data such as operation time, forceps' path lengths, and technical errors under 3D vision against 2D. Furthermore, we compared learning curve of 2D start group with 3D start groups. RESULTS: Mean operation times and technical errors were significantly improved for all tasks performed under the 3D system compared with the 2D system. In addition, mean path lengths for forceps tips were shorter for all tasks performed under the 3D system. During the first through fifth attempts, only for task 3 was the improvement rate using a 3D monitor superior to that of a 2D monitor. CONCLUSION: We found that stereoscopic images using a 3D monitor improved surgical techniques with regard to increased accuracy and shorter path lengths for forceps movement, which resulted in a shorter operation time for basic phantom laparoscopic tasks. In addition, for a moderately experienced surgeon, laparoscopic performance using a 3D monitor may have a shorter learning curve than when using a 2D monitor for a complicated laparoscopic task such as suturing.