title: The impact of crosstalk on three-dimensional laparoscopic performance and workload.
abstract: This is the first study to explore the effects of crosstalk from 3D laparoscopic displays on technical performance and workload. We studied crosstalk at magnitudes that may have been tolerated during laparoscopic surgery. Participants were 36 voluntary doctors. To minimize floor effects, participants completed their surgery rotations, and a laparoscopic suturing course for surgical trainees. We used a counterbalanced, within-subjects design in which participants were randomly assigned to complete laparoscopic tasks in one of six unique testing sequences. In a simulation laboratory, participants were randomly assigned to complete laparoscopic 'navigation in space' and suturing tasks in three viewing conditions: 2D, 3D without ghosting and 3D with ghosting. Participants calibrated their exposure to crosstalk as the maximum level of ghosting that they could tolerate without discomfort. The Randot® Stereotest was used to verify stereoacuity. The study performance metric was time to completion. The NASA TLX was used to measure workload. Normal threshold stereoacuity (40-20 second of arc) was verified in all participants. Comparing optimal 3D with 2D viewing conditions, mean performance times were 2.8 and 1.6 times faster in laparoscopic navigation in space and suturing tasks respectively (p< .001). Comparing optimal 3D with suboptimal 3D viewing conditions, mean performance times were 2.9 times faster in both tasks (p< .001). Mean workload in 2D was 1.5 and 1.3 times greater than in optimal 3D viewing, for navigation in space and suturing tasks respectively (p< .001). Mean workload associated with suboptimal 3D was 1.3 times greater than optimal 3D in both laparoscopic tasks (p< .001). There was no significant relationship between the magnitude of ghosting score, laparoscopic performance and workload. Our findings highlight the advantages of 3D displays when used optimally, and their shortcomings when used sub-optimally, on both laparoscopic performance and workload.
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, QLD, Australia. shin.sakata@gmail.com.|Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. shin.sakata@gmail.com.|Clinical Skills Development Service, Queensland Health, Herston, Brisbane, QLD, Australia. shin.sakata@gmail.com.|School of Medicine, Mayne Medical Building, University of Queensland, Herston Road, Herston, QLD 4006, Australia. shin.sakata@gmail.com.
authors.forename: Shinichiro
authors.identifier: 0000-0002-9085-6755
authors.initials: S
authors.lastname: Sakata
authors.affiliation: School of Psychology, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Grove
authors.affiliation: Clinical Skills Development Service, Queensland Health, Herston, Brisbane, QLD, Australia.|School of Psychology, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Marcus O
authors.initials: MO
authors.lastname: Watson
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, QLD, Australia.|Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.|Clinical Skills Development Service, Queensland Health, Herston, Brisbane, QLD, Australia.
authors.forename: Andrew R L
authors.initials: ARL
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D010820:Physicians; D013536:Suture Techniques; D016526:Workload / Q000706:statistics & numerical data*
keywords: 2D; 3D; Ghosting; Laparoscopy; NASA TLX; TAMIS; Three-dimensional; Transanal TME; Two-dimensional