Comparison of learning curves and skill transfer between classical and robotic laparoscopy according to the viewing conditions: implications for training.
BACKGROUND
The purpose of this study was to evaluate the perceptual (2-dimensional [2D] vs. 3-dimensional [3D] view) and instrumental (classical vs. robotic) impacts of new robotic system on learning curves.


METHODS
Forty medical students without any surgical experience were randomized into 4 groups (classical laparoscopy with 3D-direct view or with 2D-indirect view, robotic system in 3D or in 2D) and repeated a laparoscopic task 6 times. After these 6 repetitions, they performed 2 trials with the same technique but in the other viewing condition (perceptive switch). Finally, subjects performed the last 3 trials with the technique they never used (technical switch). Subjects evaluated their performance answering a questionnaire (impressions of mastery, familiarity, satisfaction, self-confidence, and difficulty).


RESULTS
Our study showed better performance and improvement in 3D view than in 2D view whatever the instrumental aspect. Participants reported less mastery, familiarity, and self-confidence and more difficulty in classical laparoscopy with 2D-indirect view than in the other conditions.


CONCLUSIONS
Robotic surgery improves surgical performance and learning, particularly by 3D view advantage. However, perceptive and technical switches emphasize the need to adapt and pursue training also with traditional technology to prevent risks in conversion procedure.
Blavier
Adélaïde
A
National Fund of Scientific Research, Cognitive Ergonomics Laboratory, University of Liège, place du 20-Août, 9à B-4000 Liège, Belgium. Adelaide.Blavier@ulg.ac.be
Gaudissart
Quentin
Q
Cadière
Guy-Bernard
GB
Nyssen
Anne-Sophie
AS
D000328:Adult; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D012371:Robotics / Q000706:statistics & numerical data*; D014796:Visual Perception