3-Dimensional versus 2-dimensional visualization on laparoscopic skills training in a low-cost simulation model: a randomized cross-over trial

Abstract Introduction Three-dimensional (3D) visualization may improve spatial orientation and depth perception during laparoscopic surgery and simulation-based training. However, the cost of commercially 3D available systems remains a major barrier to widespread implementation, particularly in resource-limited educational settings. This study aimed to compare the effects of 3D and 2D visualization on a low-cost laparoscopic simulation-basic model. Methods A randomized, comparative, crossover simulation study was conducted with 48 medical students who had completed an operative technique and experimental surgery course. Participants were randomized to perform four standardized laparoscopic tasks in one of two visualization sequences: two-dimensional high-definition followed by 3D high-definition visualization, or 3D high-definition followed by two-dimensional high-definition visualization. Task completion time and number of errors were recorded for each task and each visualization modality. A study-specific post-task questionnaire assessed perceived depth perception, performance, speed, visual adaptation, and adverse symptoms. Results Among participants who performed tasks first with two-dimensional visualization and then with three-dimensional visualization, three-dimensional visualization was associated with shorter completion times and fewer errors in all four tasks. Initial testing also favored 3D visualization in three of the four tasks. Most participants reported better depth perception (97.9%), better performance and more accurate gestures (79.2%), and faster task execution (85.4%) with three-dimensional high-definition visualization. Reported adverse symptoms included discomfort related to instrument handling, blurred vision, and dizziness. Conclusion In this low-cost simulation model, three-dimensional high-definition visualization was associated with faster task completion, fewer errors, and greater participant preference than two-dimensional high-definition visualization. These findings support low-cost stereoscopic platforms as feasible adjuncts for early laparoscopic skills acquisition and justify future comparisons with contemporary virtual-reality, haptic, and autostereoscopic training systems.