Gender benefit in laparoscopic surgical performance using a 3D-display system: data from a randomized cross-over trial

Abstract

Background The use of 3D technique compared to high-resolution 2D-4K-display technique has been shown to optimize spatial orientation and surgical performance in laparoscopic surgery. Since women make up an increasing amount of medical students and surgeons, this study was designed to investigate whether one gender has a greater benefit from using a 3D compared to a 4K-display system. Methods In a randomized cross-over trial, the surgical performance of male and female medical students (MS), non-board certified surgeons (NBCS), and board certified surgeons (BCS) was compared using 3D- vs. 4K-display technique at a minimally invasive training parkour with multiple surgical tasks and repetitions. Results 128 participants (56 women, 72 men) were included. Overall parkour time in seconds was 3D vs. 4K for all women 770.7 ± 31.9 vs. 1068.1 ± 50.0 (p < 0.001) and all men 664.5 ± 19.9 vs. 889.7 ± 31.2 (p < 0.001). Regarding overall mistakes, participants tend to commit less mistakes while using the 3D-vision system, showing 10.2 ± 1.1 vs. 13.3 ± 1.3 (p = 0.005) for all women and 9.6 ± 0.7 vs. 12.2 ± 1.0 (p = 0.001) for all men. The benefit of using a 3D system, measured by the difference in seconds, was for women 297.3 ± 41.8 (27.84%) vs. 225.2 ± 23.3 (25.31%) for men (p = 0.005). This can be confirmed in the MS group with 327.6 ± 65.5 (35.82%) vs. 249.8 ± 33.7 (32.12%), p = 0.041 and in the NBCS group 359 ± 52.4 (28.25%) vs. 198.2 ± 54.2 (18.62%), p = 0.003. There was no significant difference in the BCS group. Conclusion 3D laparoscopic display technique optimizes surgical performance compared to the 2D-4K technique for both women and men. The greatest 3D benefit was found for women with less surgical experience. As a possible result of surgical education, this gender specific difference disappears with higher grade of experience. Using a 3D-vision system could facilitate surgical apprenticeship, especially for women.

Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis

“…Four of the included studies were randomized control trials [ 17 , 18 , 20 , 31 ]; in these articles results relating to biological sex or anthropometry were secondary outcomes. The MMAT focuses on the randomization process, initial comparability, blinding, compliance, and completeness of results.…”

“…The MMAT focuses on the randomization process, initial comparability, blinding, compliance, and completeness of results. Regarding randomization, one study reported using the permuted block technique [ 17 ]; other studies made more general comments about using an independent researcher [ 18 ] or computer randomization [ 31 ]. Following randomization, resulting groups were balanced regarding biological sex in three articles [ 17 , 20 , 31 ].…”

“…Two studies reported similar baseline performance between groups [ 17 , 20 ]. Only Strandbygaard et al [ 31 ] mentioned concealing the groupings between allocation and data collection, although others stated their methods of blinding the investigators to the experimental condition of the participants [ 17 , 18 ]. Regarding compliance, Busshoff et al [ 18 ] excluded results from some tasks that were “not done according to study protocol”.…”

“…Only Strandbygaard et al [ 31 ] mentioned concealing the groupings between allocation and data collection, although others stated their methods of blinding the investigators to the experimental condition of the participants [ 17 , 18 ]. Regarding compliance, Busshoff et al [ 18 ] excluded results from some tasks that were “not done according to study protocol”. Donnon et al [ 20 ] required participants to document their adherence to the intervention of practising visualization exercises in the week between data collection sessions; however, compliance was not reported in the study results.…”

Comparing proficiency of obstetrics and gynaecology trainees with general surgery trainees using simulated laparoscopic tasks in Health Education England, North-West: a prospective observational study

“…Finally, the male:female ratio between the specialty groups was considerably different, probably reflecting the relevant population in each specialty. Although evidence points to lack of differences between male and female surgeons,40 41 future studies should aim to equate the participants based on sex, to alleviate any concerns around grouping male and female surgeons together.…”