Impact of the 2D and 3D Vision on the Learning of Fine Motor Skills According to the Instrumental Dimension: Implications for Training in Minimal Invasive Surgery

New technology in surgery is more and more present and allows to study cognitive processes in complex and natural environment. Comparing to classical minimal access surgery, a new robotic system allows to recover a 3D view and all degrees of freedom for instruments movement. The purpose of this study was to evaluate the perceptual (2D vs 3D view) and instrumental (classical versus robotic) impacts of this new robotic system on learning curves. 40 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 surgical 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 last three trials with the technique they never used (technical switch). We measured the speed, the accuracy and their subjective impressions about their performance (satisfaction, self-confidence and difficulty). Our results showed better performance and improvement in 3D view than in 2D view, whatever the instrumental aspect. In contrast, performance with 2D view was affected by the instrumental dimension. Moreover, participants reported less mastery, familiarity, self-confidence and more difficulty in classical laparoscopy with 2D view than in the other conditions. In conclusion, robotic surgery improves surgical performance and learning, particularly by 3D view advantage. However, the bad performances after the perceptive and technical switches emphasize the need to adapt and pursue training also with traditional technology in order to prevent risks when a robotic procedure has to be converted in a classical laparoscopic procedure.