title: Comparison of learning curves and skill transfer between classical and robotic laparoscopy according to the viewing conditions: implications for training.
abstract: 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.
authors.affiliation: 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
authors.forename: Adélaïde
authors.initials: A
authors.lastname: Blavier
authors.forename: Quentin
authors.initials: Q
authors.lastname: Gaudissart
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Nyssen
mesh_terms: 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