Department of General Surgery, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, Singapore, 609606, Singapore.
Clinical Research Unit, Ng Teng Fong General Hospital, Jurong Health Services, Singapore, Singapore.
Surg Endosc. 2021 Mar;35(3):1046-1051. doi: 10.1007/s00464-020-07466-y. Epub 2020 Feb 28.
Stereoscopic (3D) imaging can be used to facilitate the learning of basic laparoscopic tasks. Its advantages over traditional endoscopic (2D) imaging include better depth perception and spatial orientation. However, the transition between 3D and 2D imaging systems has not been previously studied. This study compares the acquisition of basic laparoscopic skills in a laparoscopic-naïve population using both imaging systems, and explores the possibility of a secondary learning curve in the transition between systems.
26 novice learners were randomly allocated into two arms and taught to perform two basic laparoscopic tasks adopted from the fundamentals of laparoscopic surgery (FLS) curriculum, peg transfer (T1) and pattern cutting (T2) using either 2D or 3D imaging systems. These tasks were repeated until proficiency was achieved. Participants in each arm then repeated the tasks in the other viewing system (2D/3D vs 3D/2D). The parameters measured were: (a) time taken to complete the task and (b) number of attempts to achieve proficiency.
There was a significant shortening of time required to achieve proficiency in T2 using a 3D system (mean difference-in-differences = - 65.4, 95% CI - 103.6 to - 27.2, t(24) = - 3.5, p value = 0.002) but no difference between 2D and 3D imaging systems for T1, a simpler task. Sub-group analysis of T1 and T2 between the 2D/3D and 3D/2D arms showed the presence of a secondary learning curve in the 2D/3D arm for both tasks, (T1: β-estimate - 2.68, 95% CI - 3.68 to - 1.68, p value = 0.0003; T2: β-estimate - 2.45, 95% CI - 3.75 to - 1.14, p value 0.004), but in the 3D/2D arm there was a secondary learning curve only for T2. (β-estimate 2.60, 95% CI 1.45-3.76, p value 0.001) CONCLUSION: 3D imaging can be an effective tool to speed the acquisition of proficiency in basic laparoscopic tasks for novice learners, especially in more complex tasks such as pattern cutting. The skills learned in 3D imaging can translate into 2D, albeit with a secondary learning curve.
立体（3D）成像可用于帮助学习基本的腹腔镜技能。与传统的内镜（2D）成像相比，它具有更好的深度感知和空间定位能力。然而，3D 和 2D 成像系统之间的转换尚未得到研究。本研究比较了在腹腔镜新手人群中使用这两种成像系统获取基本腹腔镜技能的情况，并探讨了在系统之间转换时可能存在的二次学习曲线。
26 名新手学习者被随机分配到两个臂中，使用 2D 或 3D 成像系统学习两项来自腹腔镜基础（FLS）课程的基本腹腔镜任务，即钉转移（T1）和模式切割（T2）。这些任务重复进行，直到熟练为止。每个臂中的参与者然后在另一个观察系统（2D/3D 与 3D/2D）中重复这些任务。测量的参数包括：（a）完成任务所需的时间和（b）达到熟练程度所需的尝试次数。
使用 3D 系统完成 T2 任务所需的时间明显缩短（差异均值差 = -65.4，95%置信区间 -103.6 至 -27.2，t(24) = -3.5，p 值 =0.002），但 2D 和 3D 成像系统在更简单的 T1 任务中没有差异。在 2D/3D 和 3D/2D 臂中对 T1 和 T2 的亚组分析表明，2D/3D 臂中的两项任务都存在二次学习曲线（T1：β估计值-2.68，95%置信区间-3.68 至-1.68，p 值=0.0003；T2：β估计值-2.45，95%置信区间-3.75 至-1.14，p 值 0.004），但在 3D/2D 臂中只有 T2 存在二次学习曲线。（β估计值 2.60，95%置信区间 1.45-3.76，p 值 0.001）
3D 成像可以成为帮助新手学习者快速掌握基本腹腔镜技能的有效工具，尤其是在模式切割等更复杂的任务中。在 3D 成像中学习的技能可以转化为 2D，但存在二次学习曲线。
