title: 3D vs. 2D imaging in laparoscopic surgery-an advantage? Results of standardised black box training in laparoscopic surgery.
abstract: OBJECTIVE
  3D imaging is an upcoming technology in laparoscopic surgery, and recent studies have shown that the modern 3D technique is superior in an experimental setting.
  
  
  METHODS
  All 14 members of the Asklepios Klinik Langen Department of Visceral and Thoracic Surgery, as well as two gynaecologists, were asked to undertake 2D vs. 3D laparoscopic black box skill training. The black box training was adapted to the "fundamentals of laparoscopic surgery" programme provided by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). First, the participants categorised themselves as beginner, advanced or expert in laparoscopic surgery. Then, they were randomised in terms of whether the black box training commenced with 2D or 3D vision. The exercises included peg transfer with the dominant hand and the non-dominant hand (with and without transfer between the graspers), needle capping and cutting a sutured knot. The time taken to complete these exercises was measured. After the training, each participant was asked to describe his/her personal impression of the imaging systems employed.
  
  
  RESULTS
  Overall, for the participants in all groups, the time required for all exercises showed a significant advantage for 3D imaging (3D vs. 2D; Wilcoxon matched pair test; mean 68.0 ± 94.9 s (3D) vs. 90.1 ± 69.4 s (2D); p = 0.002). Regarding the subgroups, the experts significantly improved their time in completing the exercises in 3D vs. 2D by a margin of 25.8 % (mean 30.8 ± 20.1 s (3D) vs. 41.5 ± 25.0 s (2D); p = 0.010). In the group of advanced surgeons, the results were similar, showing an improvement of 23.6 % for 3D, but without significance (mean 61.5 ± 41.1 s (3D) vs. 80.4 ± 72.8 s (2D); p = 0.123). The results for the beginner group also showed an improvement in the 3D exercises of 24.8 %; here, the result also showed a trend towards 3D but did not reach significance (mean 93.9 ± 90.7 s (3D) vs. 124.8 ± 118.72 (2D); p = 0.062).
  
  
  CONCLUSIONS
  In our opinion, 3D imaging could be an advantage in laparoscopic surgery, especially in the surgical education of upcoming surgical generations. To determine whether these ex vivo results can be transferred to the clinical situation, our group has initiated a randomised controlled study.
authors.affiliation: Department of General and Visceral Surgery, St. Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University Frankfurt, Ginnheimer Str. 3, 60487, Frankfurt, Germany. a.buia@katharina-kasper.de.
authors.forename: A
authors.initials: A
authors.lastname: Buia
authors.affiliation: Department of General and Visceral Surgery, St. Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University Frankfurt, Frankfurt, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Stockhausen
authors.affiliation: Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Filmann
authors.affiliation: Department of Visceral and Thoracic Surgery, Asklepios Klinik Langen, Academic Teaching Hospital, Goethe-University Frankfurt, Langen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Hanisch
mesh_terms: D002983:Clinical Competence; D006801:Humans; D021621:Imaging, Three-Dimensional; D007318:Inservice Training; D010535:Laparoscopy / Q000193:education*; D010865:Pilot Projects; D000066908:Simulation Training
keywords: 3D laparoscopy; Black box skill training; Laparoscopic surgery