Journal of Surgical Simulation 2018; 5: 1 - 7

Published: 17 April 2018


Original article

Impact of 3D laparoscopic surgical training on performance in standard 2D laparoscopic simulation: a randomised prospective study

Ricardo A.R. de Almeida, Yassar A. Qureshi, Alpa J. Morawala, Nabeel H. Merali, Ikechuwku Iloabachie, Badriya Alaraimi and Bijendra Patel
Corresponding author: Yassar A. Qureshi, Teaching Centre, Barts Cancer Institute, Queen Mary College, University of London, Charterhouse Square, London EC1M 6BQ, UK. Email:


Background: Laparoscopic surgery is based on 2D imaging, with limited depth perception. The aim of this study was to analyse the impact of 3D training on the performance of surgical trainees in 2D laparoscopic simulation.

Methods: Thirty medical students were randomised into group A, completing five training attempts of three modified Fundamentals of Laparoscopic Surgery tasks (peg transfer, pattern cutting, and intra-corporeal suturing) using a 3D simulator, or group B, who were only exposed to the 2D platform. Time to completion, error rate, and efficiency improvement were measured.

Results: The overall performance time was lower for group A than for group B, and this was statistically significant in task 2 (P = 0.02) and task 3 (P<0.01). The mean error rate was lower for group A versus group B, which was statistically significant for all three tasks (task 1, 0 vs 0.2; task 2, 0.4 vs 1.8; task 3, 0.24 vs 1.1). When efficiency improvement was evaluated, group B displayed a faster rate of improvement during task 1 (132.1% vs 248.8%; P<0.01) and task 2 (123.9% vs 139%; P = 0.15). For task 3, group A demonstrated a superior rate of improvement (190% vs 173.1%; P = 0.2).

Conclusions: Introducing 3D training is beneficial for novices to execute 2D laparoscopic skills, particularly for complex tasks where depth perception is critical. 3D-based laparoscopic training, in conjunction with standard 2D platforms, should be introduced into surgical training to facilitate quicker and better preparation before translation of these skills into clinical practice.


three-dimensional; two-dimensional; laparoscopic surgery; simulation training; medical education