General and Mininvasive Surgery Department, Pederzoli Hospital, Via Monte Baldo 24, Peschiera del Garda, 37019, Verona, Italy.
Bioengineering and Medical-Surgical Sciences, Politecnico Di Torino, Torino, Italy.
Surg Endosc. 2020 Jul;34(7):3262-3269. doi: 10.1007/s00464-020-07524-5. Epub 2020 Apr 1.
Three-dimensional (3d) laparoscopy has been introduced to enhance depth perception and facilitate surgical operations. The aim of this study was to compare cognitive load during 3d and 2d laparoscopic procedures.
Two subjective questionnaires (the Simulator Sickness Questionnaire and the NASA task load index) were used to prospectively collect data regarding cognitive load in surgeons performing 2d and 3d laparoscopic colorectal resections. Moreover, the perioperative results of 3d and 2d laparoscopic operations were analyzed.
A total of 313 patients were included: 82 in the 2d group and 231 in the 3d group. The NASA TLX results did not reveal significantly major cognitive load differences in the 3d group compared with the 2d group; the SSQ results were better in the 3d group than in the 2d group in terms of general discomfort, whereas difficulty concentrating, difficulty focusing, and fatigue were more frequent in 3d operations than in 2d operations (p = 0.001-0.038). The results of age, sex, and ASA score were comparable between the two groups (p = 0.299-0.374). The median operative time showed no statistically significant difference between the 3d and 2d groups (median, IQR, 2d 150 min [120-180]-3d 160 min [130-190] p = 0.611). There was no statistically significant difference in the risk of severe complications between patients in the 3d group and in the 2d group (2d 7 [8.54%] vs 3d 21 [9.1%], p = 0.271). The median hospitalization time and the reoperation rate showed no difference between the 2d and 3d operations (p = 0.417-0.843).
The NASA TLX did not reveal a significant difference in cognitive load between the 2d and 3d groups, whereas data reported by the SSQ showed a mild risk of cognitive load in the 3d group. Furthermore, 3d laparoscopic surgery revealed the same postoperative results as 2d standard laparoscopy.
三维（3d）腹腔镜技术的引入旨在增强深度感知，便于手术操作。本研究旨在比较 3d 和 2d 腹腔镜手术中的认知负荷。
采用 2 种主观问卷（模拟器晕动病问卷和 NASA 任务负荷指数）前瞻性收集行 2d 和 3d 腹腔镜结直肠切除术的外科医生的认知负荷数据。此外，还分析了 3d 和 2d 腹腔镜手术的围手术期结果。
共纳入 313 例患者：2d 组 82 例，3d 组 231 例。NASA TLX 结果显示，3d 组的认知负荷与 2d 组无显著差异；3d 组的 SSQ 结果总体不适优于 2d 组，而集中注意力困难、聚焦困难和疲劳在 3d 手术中比 2d 手术更常见（p=0.001-0.038）。两组间年龄、性别和 ASA 评分结果相当（p=0.299-0.374）。3d 组和 2d 组的中位手术时间无统计学差异（中位数，IQR，2d 组 150 分钟[120-180]-3d 组 160 分钟[130-190]，p=0.611）。3d 组和 2d 组严重并发症风险无统计学差异（2d 组 7 例[8.54%]vs 3d 组 21 例[9.1%]，p=0.271）。2d 组和 3d 组的中位住院时间和再次手术率无差异（p=0.417-0.843）。
NASA TLX 未显示 2d 和 3d 组间认知负荷有显著差异，而 SSQ 数据显示 3d 组认知负荷轻度升高。此外，3d 腹腔镜手术与 2d 标准腹腔镜手术具有相同的术后结果。
