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Cognitive load in 3d and 2d minimally invasive colorectal surgery

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Abstract

Background

Three-dimensional (3d) laparoscopy has been introduced to enhance depth perception and facilitate surgical operations. The aim of this study was to compare cognitive load during 3d and 2d laparoscopic procedures.

Methods

Two subjective questionnaires (the Simulator Sickness Questionnaire and the NASA task load index) were used to prospectively collect data regarding cognitive load in surgeons performing 2d and 3d laparoscopic colorectal resections. Moreover, the perioperative results of 3d and 2d laparoscopic operations were analyzed.

Results

A total of 313 patients were included: 82 in the 2d group and 231 in the 3d group. The NASA TLX results did not reveal significantly major cognitive load differences in the 3d group compared with the 2d group; the SSQ results were better in the 3d group than in the 2d group in terms of general discomfort, whereas difficulty concentrating, difficulty focusing, and fatigue were more frequent in 3d operations than in 2d operations (p = 0.001–0.038). The results of age, sex, and ASA score were comparable between the two groups (p = 0.299–0.374). The median operative time showed no statistically significant difference between the 3d and 2d groups (median, IQR, 2d 150 min [120–180]—3d 160 min [130–190] p = 0.611). There was no statistically significant difference in the risk of severe complications between patients in the 3d group and in the 2d group (2d 7 [8.54%] vs 3d 21 [9.1%], p = 0.271). The median hospitalization time and the reoperation rate showed no difference between the 2d and 3d operations (p = 0.417–0.843).

Conclusion

The NASA TLX did not reveal a significant difference in cognitive load between the 2d and 3d groups, whereas data reported by the SSQ showed a mild risk of cognitive load in the 3d group. Furthermore, 3d laparoscopic surgery revealed the same postoperative results as 2d standard laparoscopy.

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References

  1. Durrani AF, Preminger GM (1995) Three-dimensional video imaging for endoscopic surgery. Comput Biol Med 25(2):237–247

    Article  CAS  Google Scholar 

  2. Mueller MD, Camartin C, Dreher E, Hänggi W (1999) Three dimensional laparoscopy. Gadget or progress? A randomized trial on the efficacy of three-dimensional laparoscopy. Surg Endosc 13(5):469–472

    Article  CAS  Google Scholar 

  3. Chan A, Chung SC, Yim AP, Lau JY, Ng EK, Li AK (1997) Comparison of two-dimensional vs three-dimensional camera system in laparoscopic surgery. Surg Endosc 11:438–440

    Article  CAS  Google Scholar 

  4. van Bergen P, Kunert W, Buess GF (1999) Three-dimensional (3-D) video systems: bi-channel or single-channel optics? Endoscopy 31(9):732–737

    Article  Google Scholar 

  5. Honeck P, Wendt-Nordahl G, Rassweiler J, Knoll T (2012) Threedimensional laparoscopic imaging improves surgical performance on standardized ex-vivo laparoscopic tasks. J Endourol 26(8):1085–1088

    Article  Google Scholar 

  6. Urey H, Chellappan KV, Erden E, Surman P (2011) State of the art in stereoscopic and autostereoscopic displays. Proc IEEE 99:540–555

    Article  Google Scholar 

  7. Malik AS, Khairuddin RN, Amin HU, Smith ML, Kamel N, Abdullah JM, Fawzy SM, Shim S (2015) EEG based evaluation of stereoscopic 3D displays for viewer discomfort. Biomed Eng 11(14):21

    Google Scholar 

  8. Doughty MJ (2002) Further assessment of gender- and blink pattern-related differences in the spontaneous eye blink activity in primary gaze in young adult humans. Optom Vis Sci 79(7):439–447

    Article  Google Scholar 

  9. Sforza E, Jouny C, Ibanez V (2000) Cardiac activation during arousal in humans: further evidence for hierarchy in the arousal response. Clin Neurophysiol 111(9):1611–1619

    Article  CAS  Google Scholar 

  10. Park S, Won MJ, Mun S, Lee EC, Whang M (2014) Does visual fatigue from 3D displays affect autonomic regulation and heart rhythm? Int J Psychophysiol. https://doi.org/10.1016/j.ijpsycho.2014.02.003

    Article  PubMed  Google Scholar 

  11. Hart Sandra G, Staveland Lowell E (1988) Development of NASA-TLX (task load index): results of empirical and theoretical research. In: Hancock PA, Meshkati N (eds) Human mental workload. Advances in psychology, vol 52. Amsterdam: North Holland, pp 139–183. https://doi.org/10.1016/S0166-4115(08)62386-9

  12. Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG (1993) Simulator sickness questionnaire: an enhanced method for quantifying simulator sickness. Int J Aviat Psychol 3(3):203–220

    Article  Google Scholar 

  13. Kinoshita H, Nakagawa K, Usui Y, Iwamura M, Ito A, Miyajima A, Hoshi A, Arai Y, Baba S, Matsuda T (2015) High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems. Surg Endosc 29(8):2203–2209

    Article  Google Scholar 

  14. Solimini AG (2013) Are there side effects to watching 3D movies? A prospective crossover observational study on visually induced motion sickness. PLoS ONE 8(2):e56160. https://doi.org/10.1371/journal.pone.0056160

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sakata S, Grove PM, Hill A, Grove PM, Hill A, Watson MO, Stevenson AR (2016) The viewpoint-specific failure of modern 3D displays in laparoscopic surgery. Langenbecks Arch Surg 401(7):1007–1018

    Article  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  17. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 37(2):259–284

    Article  CAS  Google Scholar 

  18. Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN, Ljungqvist O, Soop M, Ramirez J (2013) Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 37(2):285–305

    Article  CAS  Google Scholar 

  19. Ernesto A Bustamante, Randal D Measurement invariance of the Nasa TLX, Proceedings of the Human Factors and Ergonomics Society, Annual Meeting. 52: 1522–1526

  20. Schwab K, Smith R, Brown V, Whyte M, Jourdan I (2017) Evolution of stereoscopic imaging in surgery and recent advances. World J Gastrointest Endosc 9(8):368–377

    Article  Google Scholar 

  21. Park S, Won MJ, Mun S, Lee EC, Whang M (2014) Does visual fatigue from 3D displays affect autonomic regulation and heart rhythm? Int J Psychophysiol pii S0167–8760(14):00056–57

    Google Scholar 

  22. Berguer R, Gerber S, Kilpatrick G, Remler M, Beckley D (1999) A comparison of forearm and thumb muscle electromyographic responses to the use of laparoscopic instruments with either a finger grasp or a palm grasp. Ergonomics 42(12):1634–1645

    Article  CAS  Google Scholar 

  23. Gurusamy KS, Sahay S, Davidson BR (2011) Three dimensional versus two-dimensional imaging for laparoscopic cholecystectomy. Cochrane Database Syst Rev 19(1):CD006882

    Google Scholar 

  24. Komaei I, Navarra G, Currò G (2017) Three-dimensional versus two-dimensional laparoscopic cholecystectomy: a systematic review. J Laparoendosc Adv Surg Tech A 27(8):790–794

    Article  Google Scholar 

  25. Tao K, Liu X, Deng M, Shi W, Gao J (2016) Three-dimensional against 2-dimensional laparoscopic colectomy for right-sided colon cancer. Surg Laparosc Endosc Percutan Tech 26(4):324–327

    Article  Google Scholar 

  26. Vettoretto N, Foglia E, Ferrario L, Arezzo A, Cirocchi R, Cocorullo G, Currò G, Marchi D, Portale G, Gerardi C, Nocco U, Tringali M, Anania G, Piccoli M, Silecchia G, Morino M, Valeri A, Lettieri E (2018) Why laparoscopists may opt for three-dimensional view: a summary of the full HTA report on 3D versus 2D laparoscopy by SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie). Surg Endosc 32(6):2986–2993

    Article  Google Scholar 

  27. Arezzo A, Vettoretto N, Francis NK, Bonino MA, Curtis NJ, Amparore D, Arolfo S, Barberio M, Boni L, Brodie R, Bouvy N, Cassinotti E, Carus T, Checcucci E, Custers P, Diana M, Jansen M, Jaspers J, Marom G, Momose K, Müller-Stich BP, Nakajima K, Nickel F, Perretta S, Porpiglia F, Sánchez-Margallo F, Sánchez-Margallo JA, Schijven M, Silecchia G, Passera R, Mintz Y (2019) The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 33(10):3251–3274

    Article  Google Scholar 

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Authors and Affiliations

  1. General and Mininvasive Surgery Department, Pederzoli Hospital, Via Monte Baldo 24, Peschiera del Garda, 37019, Verona, Italy

    M. Inama, H. Impellizzeri, M. Bacchion, M. Creciun, A. Casaril & G. Moretto

  2. Bioengineering and Medical-Surgical Sciences, Politecnico Di Torino, Torino, Italy

    M. Inama

  3. Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy

    G. Spolverato

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  1. M. Inama
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  2. G. Spolverato
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Correspondence to M. Inama.

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Disclosures

Drs. Inama M, Spolverato G, Impellizzeri H, Bacchion M, Creciun M, Casaril A, Moretto G. have no conflicts of interest or financial ties to disclose.

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Inama, M., Spolverato, G., Impellizzeri, H. et al. Cognitive load in 3d and 2d minimally invasive colorectal surgery. Surg Endosc 34, 3262–3269 (2020). https://doi.org/10.1007/s00464-020-07524-5

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