Perceptual and instrumental impact of new technology on surgical performance.

Contradictory results were reported concerning the benefits of three-dimensional systems and new technology on surgical performance. Our study aimed to precisely evaluate perceptual and instrumental impact of new robotic technology on surgical performance and subjective impression. 60 medical students without any surgical experience were randomized into three groups (classical laparoscopy, robotic system in 3D or robotic system in 2D). After a familiarisation phase with the technique of their condition, they performed four tasks of increasing complexity and self-evaluated their performance answering a questionnaire. Finally, subjects performed the most difficult task with the technique they never used (technical switch). Our results showed significant better performance with classical laparoscopy than with robotic system in the familiarisation task. In the following tasks of increasing complexity, subjects significantly performed better, with more self-confidence, satisfaction and facility using robotic system in 3D than with classical laparoscopy. Robotic system in 2D provided significant worse results than 3D robotic system except for the last and most difficult task. Depth perception plays predominant role in easiest tasks whereas instrumental dimension is a determinant factor in performing finest tasks. Results are discussed in terms of consequences of new technology introduction for patient safety and surgeon’s training.