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Nima Motahariasl,1 Sayed Borna Farzaneh,1 Sina Motahariasl,2 Ilya Kokotkin,3 Sara Sousi,4,5 Alexander Zargaran,5,6 David Zargaran,7 Bijendra Patel8 1St George’s Hospital NHS Trust, London, SW17 0QT, Greater London, UK; 2Lewisham and Greenwich NHS Trust, London, SE13 6LH, Greater London, UK; 3St George’s University of London, London, SW17 0RE, Greater London, UK; 4Department of Surgery and Cancer, Imperial College London, London, W12 0NN, Greater London, UK; 5King’s College London, London, SE1 1UL, Greater London, UK; 6Chelsea and Westminster Hospital, London, SW10 9NH, Greater London, UK; 7Royal Free Hospital, London, NW3 2QG, Greater London, UK; 8Barts Cancer Institute, Queen Mary University of London, London, EC1M 5PZ, Greater London, UKCorrespondence: Sara SousiDepartment of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0NN, Greater London, UKEmail ss6319@ic.ac.ukAim: The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDexTM laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems.Methods: In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDexTM and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves.Results: The intervention group that used FlexDexTM and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDexTM with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001).Conclusion: Combination of 3D visual systems and the FlexDexTM laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance.Key Statement: 3D visual systems lead to faster task completion times when combined with an articulating laparoscopic needle holder compared to 2D vision. This effect however is not seen in error rates.Keywords: laparoscopic skills, advanced bimanual skills, 2D, 3D, FlexDex™ |
