Effect of visual feedback on surgical performance using the da Vinci® Surgical System

Background: Robotic surgical systems quantify human movements in terms of position, velocity, and time span. This information can be used to objectively assess surgical skill. The aim of this study was to test the effects of three-dimensional vs. two-dimensional visualization on performance using the da Vinci (R) Surgical System (Intuitive Surgical, Sunnyvale, CA). Materials and Methods: The movements of novice and expert surgeons were recorded using the da Vinci (R) Surgical System for a two-handed task in two visual environments (two-dimensional and three-dimensional). Data were analyzed to investigate the effect of visual feedback on performance. Results: Velocities and task completion times were significantly different for novices and experts (P < 0.05) for all velocity parameters in both visual conditions. Additionally, there was a significant difference between two-dimensional and three-dimensional times for novices (P < 0.05). Novices were idle significantly longer in two-dimensional than in three-dimensional visual input (P = 0.037), and overall, novices were idle longer than experts for both visual conditions (P = 0.001). Conclusion: Three-dimensional visual input allows novice surgeons to perform tasks with higher velocities, less idle time, and greater economy of motion. However, three-dimensional visual input provides no significant enhancement of performance for expert surgeons.