title: Skills Comparison in Pediatric Residents Using a 2-Dimensional versus a 3-Dimensional High-Definition Camera in a Pediatric Laparoscopic Simulator.
abstract: BACKGROUND
  Advantages in 3-dimensional (3D) laparoscopy are mostly described in adults for better depth perception, precise visualization of anatomical structures, as well as for complex surgical maneuvers in small spaces. Using Visionsense III stereoscopic endoscopy system (Neuromed Spa), we performed a comparative study between surgical skills achievements using 2-dimensional (2D) and 3D laparoscopic equipment in a pediatric laparoscopic surgery simulator model.
  
  
  METHODS
  Three skills were evaluated both in 2D and 3D modalities. Pediatric residents (n = 20) without any previous laparoscopic experience were randomly divided in 2 groups and evaluated doing the established tasks in a laparoscopic simulator validated for pediatric surgery. Switching the type of vision from 2D to 3D or vice versa, we evaluated bimanual dexterity, efficiency, and efficacy. Three tasks were proposed-task 1: transfer of objects (6 pegs transferred one-by-one on a pegboard); task 2: pattern cutting (cutting a paper, following a circular dotted line); and task 3: threading eyelet (transfer, twisting and passing through a eyelet-shaped support, a specific 3D object). Performance was measured using a scoring system rewarding precision and speed. Any physical discomfort related to the 3D vision was recorded.
  
  
  RESULTS
  Of the 20 participants included, 10 began the skills in the 2D modality and then performed them in 3D, and the other 10 began in 3D and ended in 2D. Overall task 1 performance (time and number of errors) was significantly better using stereoscopic compared with monoscopic visualization. Both groups experienced a 35.6% decrease in the time needed to complete the peg transfer using 3D instead of 2D. In task 2, the 3D performance was superior (less time to correctly cut the paper along the dotted line), but did not reach statistical significance. In task 3, the residents experienced with 3D a 31.7% decrease in the time necessary to complete the passage of the object trough the eyelet. Most participants (65%) "subjectively" defined 3D laparoscopy easier overall; 6 participants (30%) did not experience any issue related to the use of 3D technology; and 1 person (5%) of group 1 found more difficulties using 3D compared with 2D. Headache (25%), nausea (20%), and visual disturbance (1%) were the most common issues reported by the students during 3D procedures. Finally, the results show that residents achieved significantly better results working with 3D vision rather than with 2D vision.
  
  
  CONCLUSIONS
  As other studies have demonstrated, there was improvement in the overall performance using the 3D laparoscope. This was the first attempt to verify 3D skills in naive subjects, directly on a simulator conceived exclusively for pediatric surgery; therefore, bias was limited by using a population without surgical experience.
  
  
  CONCLUSIONS
  3D laparoscopic surgical skills showed superior to 2D, with higher percentages of tasks completion, less time in performing them, and a shorter learning curve. Our results indicate that 3D was subjectively easier than 2D in performing complex tasks in the skills laboratory setting.
authors.affiliation: Division of Pediatric General, Thoracic, & Minimally Invasive Surgery, AOU Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Torino, Italy. Electronic address: rguana@cittadellasalute.to.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Guanà
authors.affiliation: Division of Pediatric General, Thoracic, & Minimally Invasive Surgery, AOU Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Torino, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Ferrero
authors.affiliation: Division of Pediatric General, Thoracic, & Minimally Invasive Surgery, AOU Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Torino, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Garofalo
authors.affiliation: Division of Pediatric General, Thoracic, & Minimally Invasive Surgery, AOU Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Torino, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Cerrina
authors.affiliation: Division of Pediatric General, Thoracic, & Minimally Invasive Surgery, AOU Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Torino, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cussa
authors.affiliation: Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Division of Pediatric General, Thoracic, & Minimally Invasive Surgery, AOU Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Torino, Italy.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Schleef
mesh_terms: D002983:Clinical Competence; D003867:Depth Perception; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D010372:Pediatrics / Q000193:education*; D011597:Psychomotor Performance; D000066908:Simulation Training; D013647:Task Performance and Analysis
keywords: 3-dimensional; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; laparoscopic simulator; laparoscopy; pediatric surgery