# Early-phase laparoscopic skill acquisition in veterinary students: impact of 2D/3D vision and conventional/articulating instruments

## TL;DR

This study examines how 2D/3D vision and conventional/articulating instruments affect early laparoscopic skill learning in veterinary students.

## Contribution

The study introduces the performance improvement (Pi) score as a valid metric for early-phase laparoscopic training in veterinary students.

## Key findings

- CLI groups showed greater performance improvement in peg transfer and needle guidance compared to ALI groups.
- 3D vision consistently showed higher Pi scores than 2D across all tasks.
- The Pi score effectively reflects both time and error in early laparoscopic training.

## Abstract

Minimally invasive surgery has been increasingly adopted for its advantages of reduced postoperative pain and faster recovery, underscoring the importance of structured basic skills training. In human medicine, robotic surgery addresses the limitations of conventional laparoscopy, but widespread adoption in veterinary practice is constrained by cost and logistics. The potential for cost-effective alternatives such as three-dimensional (3D) visualization and novel articulating laparoscopic instruments (ALI) is growing, but evidence for their impact on novice training remains limited. This study investigated the influence of visualization systems (two-dimensional (2D) vs. 3D) and instrument types (conventional laparoscopic instruments (CLI) vs. ALI) on early-phase laparoscopic skill acquisition in veterinary students, and to assess feasibility of the performance improvement (Pi) score as an integrated metric.

Forty-eight students with no prior laparoscopic experience were randomized into four groups: 2D + CLI, 2D + ALI, 3D + CLI, and 3D + ALI (n = 12 per group). All the participants completed five repetitions of three standardized tasks on a box trainer (peg transfer, pattern cutting, needle guidance). The Pi scores were significantly positively correlated reductions in completion time (ρ = 0.443–0.674, p ≤ 0.002) and errors (ρ = 0.538–0.851, p < 0.001) across tasks. Compared with the ALI group, CLI groups achieved significantly greater performance improvements in peg transfer (F(1,44) = 5.251, p = 0.027; partial η² = 0.107) and needle guidance (F(1,44) = 9.435, p = 0.004; partial η² = 0.177). Although the main effect of vision was not significant, 3D group showed a consistent trend toward higher mean Pi scores than 2D group in all tasks (peg transfer: 1.384 vs. 1.338; pattern cutting: 1.350 vs. 1.311; needle guidance: 1.393 vs. 1.343). No interaction effects were detected. The Simulator Sickness Questionnaire and NASA Task Load Index scores did not differ between the groups.

The Pi score provides a valid, comprehensive index reflecting both time and error in early-phase of laparoscopic training, enabling grade-based feedback. Compared with the ALI, the CLI showed higher short-term performance improvement in peg transfer and needle guidance. 3D vision has the potential to alleviate visuomotor demands without inducing simulator sickness. These findings suggest that laparoscopic training should be adapted to individual performance levels, learning objectives, and equipment-specific demands.