2D vs 3D Video Enhanced Remote Learning for Laparoscopic Skills Training -- A Randomized Trial
Arthi Hannallah, MD1, Thalia Bajakian, MD2, Hannah Dillon, BS1, Andy Chang, MD1, Scott Sparks, MD1, Paul Kokorowski, MD, MPH3, Zoë G. Baker, PhD1.
1Children's Hospital Los Angeles, Los Angeles, CA, USA, 2Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, 3Cedars Sinai Medical Center, Los Angeles, CA, USA.
BACKGROUND: Remote learning for surgical skills can augment in-person surgical and procedural training. This study investigates whether reviewing a three-dimensional (3D) video as compared to a standard two-dimensional (2D) video of a laparoscopic task improves participants' laparoscopic progress in a practical assessment.
METHODS: This was a prospective block-randomized controlled study involving staff from a pediatric hospital. Surgical trainees above postgraduate year two training in a surgical residency were excluded. Participants were initially given a task to move a set of six blocks on a pegboard laparoscopically (Figure 1). All participants were read the same script with basic instructions regarding the task. Time to task completion, number of times pegs were dropped, number of times pegs were partially/incorrectly placed, and self-reported task difficulty were assessed. After the initial assessment, participants were randomized 1:1 to 2D or 3D study arms and were given access to either a 2D video or a 3D video with a cardboard 3D viewer, both of which were formatted to view on a smartphone. After a two-week period, participants returned to perform the laparoscopic peg transfer skills assessment for a second time. Results were analyzed using paired t-tests, Z-tests, McNemar's Test, and linear regression analyses.
RESULTS: Sixty participants - 30 in each arm - completed both visits. Participants took an average of 224.4 seconds (±85.3s) to complete the task before watching the instructional video, and 183.1 seconds (±60.8s) to complete the task after watching the video. Time to completion was significantly shorter (p=0.001) among all participants after watching the instructional video. Video type - 2D vs. 3D - was not significantly associated with difference in completion time (p=0.89). The proportion of participants rating the task as "easy" or "very easy" increased significantly from 13.3% to 36.7% (p=0.04) only among participants who watched the 3D video (2D video 10.0% to 13.3%; p=0.69). The proportion of participants who placed at least one peg incorrectly significantly decreased from 66.7% at first visit to 23.3% (p=0.001) at second visit only among participants who watched the 3D video (2D video 63.3% to 43.3%; p= 0.12). Being in the 2D versus 3D group was not significantly associated with reduced number of pegs dropped after watching the video (p=0.60 for 3D group, p=0.41 for 2D group). Overall, 86.7% found the 3D instructional video helpful or very helpful, and 96.7% found the 3D video realistic or very realistic. Comparatively, 83.3% found the 2D video helpful or very helpful, and 90.0% found the 2D video realistic or very realistic.
CONCLUSIONS: 3D remote learning training videos for laparoscopic peg transfer increases perceived ease of performance and increases accuracy in peg placement, compared to 2D training videos. Remote 3D learning is a promising method of improving laparoscopic skills training programs. 
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