The expected advantages of the 3D system include an improved learning curve with greater speed, optimised precision and fewer mistakes that result in shorter operation times, fewer complications and cost reduction.
There was no difference regarding the sequence in which the systems were used, and in all tasks the expert group was significantly faster than the student and non-expert groups.
In practice, a 0° optic is not standard anymore, as many surgeons use a 30° optic. At the time this study was conducted, a 3D 30° optic from Storz (Karl Storz SE & Co., Tuttlingen, Germany) was unavailable. Therefore, a 0° optic was used with the 2D system; thus, some of the experts or non-experts may have experienced issues with the unusual perspective.
We anticipated that the 3D system would have a distinct advantage for all of the groups and tasks. Overall, a reduction in mistakes and time was achieved. Group B performed 20% faster, on average, during all 4 tasks and made fewer mistakes in 2 of the tasks compared to group A. The experts significantly benefited from the 3D system in terms of accuracy when performing the ball-throwing exercise compared to the non-experts and students (Table 2). The students, however, showed a significantly greater benefit when using the 3D system in terms of less accidental contact in comparison to experts and non-experts when performing task 3 (Table 3). All participants rated the 3D tasks as easier to perform; and, this rating was significant for the first 3 tasks. The number of tasks that were needed before the candidates adjusted to the perspective did not differ between the 2D and 3D systems. Loss of concentration occurred at the same rate and after the same amount of time for both systems as well. Nausea and dizziness were reported only when working with the 3D system. As a result of the learning effect, the participants performed the second round of trials better than the first round. This effect was especially evident in the beginners, suggestive of a novelty effect, as the more experienced the candidates were, the smaller the effect of the 3D system. According to the subjects’ perceptions, the 3D system gave them an advantage. Nearly 100% of the subjects considered the 3D system as beneficial, with disadvantages, as nausea and dizziness or handicapped by the 3D glasses because of the glasses fogging-up with movement and losing the 3D view when turning the head sideways, noticed only occasionally.
This work supports previous studies investigating the benefits of this technology and explains the disadvantages in detail, such as the hindrance experienced when using goggles, loss of concentration and headache [7, 8, 9, 10]. Measurements were also taken from non-experts. Doctors-in-training have not previously participated in research measuring the benefits of 3D. Their inclusion is another factor that suggests the 3D technique can be easily incorporated into routine LSCs, which are currently an important aspect of modern surgery [11, 12, 13]. There are examples of robot-assisted LSCs, such as the Da Vinci, which benefits from 3D visualization and increased degrees of freedom to provide better results [14, 15]. However, the combination of 3D and conventional LSC offers a more cost-effective and simpler alternative to the Da Vinci [16, 17]. Yet, this technology is still in the developmental phase, thus our work should be seen as a contribution to help move this technology forward [11, 18, 19, 20].
In some clinics, the 3D system is available in the operation theatre as a permanent feature, but is rarely used. As this study suggests, surgeons should start using 3D systems early in their operating career, as the effects are substantial for beginners and the learning curve can be improved. This is especially important as there are fewer operations due to an increase in the number of conservative procedures based on better alternative treatments or diagnostics [21, 22, 23, 24, 25, 26]. This is also an approach that may prove useful in increasing the use of robot-assisted LSC using simple tools. A multi-centre study comparing the outcome of operations using 3D systems in conventional LSC and robot-assisted LSC should be considered for future studies.