Department of Surgery, University of Nevada School of Medicine, 1707 W. Charleston Blvd. Suite 160, Las Vegas, NV, 89102, USA.
Surg Endosc. 2017 Nov;31(11):4625-4630. doi: 10.1007/s00464-017-5525-x. Epub 2017 Apr 13.
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.
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.
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).
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.
研究表明，由于机器人辅助腹腔镜手术（RL）具有机械优势，因此与传统腹腔镜手术（CL）相比，其手术表现更好，但尚未评估干扰是否为一个因素。为了确定 RL 中 3D 光学的沉浸式方面是否有助于提高手术表现，我们比较了仅使用达芬奇的 3D 光学与使用和不使用干扰的传统 2D 监视器进行腹腔镜技能的结果。
32 名没有任何腹腔镜经验的参与者被平均随机分为四组：RL、机器人辅助腹腔镜手术加干扰（RL+D）、CL 和常规腹腔镜手术加干扰（CL+D）。每组参与者完成三项腹腔镜手术基本技能任务[钉转移（任务 1）、圆圈切割（任务 2）和打结缝合（任务 3）]，每个任务重复三次。记录每个任务的平均时间和错误，并对每组数据进行统计分析。
与其他组相比，CL+D 在完成任务 1 时平均多花了 1 分钟（P=0.001），完成任务 2 时多花了 1 分钟以上（P=0.003），完成任务 3 时多花了 2 分钟以上（P<0.001）。在任务 2 中，与 CL 和 CL+D 相比，RL 和 RL+D 的偏离模式更短（分别为 0.33cm 和 0.37cm 与 0.55cm 和 0.58cm，P<0.001）。在任务 3 中，RL 和 RL+D 的偏差也比 CL 和 CL+D 短（分别为 0.23mm 和 0.24mm 与 0.61mm 和 0.63mm，P<0.001）。
当引入干扰时，CL 的表现明显变差。这表明使用传统的 2D 显示器并不能帮助消除干扰。对于需要更高精度和深度感知的任务 2 和任务 3，使用 3D 光学的组的平均偏差比使用传统 2D 显示器的组短。这表明，即使达芬奇的机械臂被移除，沉浸式 3D 光学仍具有优势，尤其是在存在干扰的情况下。3D 光学的沉浸式方面可能有助于提高手术室的手术表现，使外科医生更专注于手术，并具有更高的深度感知能力。
