Dry box training with three-dimensional vision for the assistant surgeon in robot-assisted urological surgery

We analyzed whether three-dimensional vision, practice or previous laparoscopic experience improves the surgical performance of the bedside assistant during robot-assisted surgery. Six experienced laparoscopic surgeons and 15 novices carried out three skills drills imitating an assistant's maneuvers in robot-assisted surgery, and times for completing the tasks were recorded. Both the novice and experienced groups showed significantly shorter manipulation times for each drill with three-dimensional vision compared with two-dimensional or glassless three-dimensional vision. The experienced group showed significantly shorter manipulation times than the novice group for all types of vision. A significant improvement was observed 14 out of 18 times in the novice group, but only one out of 18 times in the experienced group. We can conclude that the use of three-dimensional visualization facilitates the performance of the assistant surgeon, especially if a novice, during robot-assisted surgery. Laparoscopic experience also improves the performance, whereas training is beneficial for novice assistant surgeons before carrying out actual operations.