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A structured learning curve for visuomotor recalibration and surgical performance during transition from
Xiaodong Qing1, Xiangzheng Wu2, Wenbo Gao2
1Department of Surgery, Ningbo Integrated Traditional Chinese and Western Medicine Hospital, Ningbo, Zhejiang, China.
Background:
Three-dimensional (3D) laparoscopy offers stereoscopic depth perception, but moving from conventional two-dimensional (2D) systems calls for a period of visuomotor adaptation. How this learning curve unfolds in complex oncological procedures like laparoscopic radical cystectomy (LRC) has not been well characterized.
Methods:
This single-surgeon retrospective cohort study included 140 consecutive patients who underwent LRC by an experienced surgeon (>300 prior 2D procedures). Cases were divided chronologically into one 2D group (the last 50 2D cases) and three consecutive 3D groups (3D-1 to 3D-3, 30 cases each). The primary endpoint was pelvic-phase operative time- the vision-dependent part of dissection. Secondary outcomes included estimated blood loss (EBL), lymph node yield, positive margin rate, major complications (Clavien-Dindo ≥II), and surgeon-rated stereoscopic comfort and hand-eye coordination (visual analogue scales).
Results:
Baseline characteristics were similar across groups. Change-point analysis identified a single significant transition point at case 31 (95% CI: 28-34). Pelvic-phase time in 3D-1 group (median 198 min) was comparable to the 2D reference (185 min, P> 0.05), marking an adaptation phase. After that, time fell sharply to 155 min in 3D-2 group and 152 min in 3D-3 group (both P< 0.001 vs. groups 2D and 3D-1). EBL dropped from 450 mL (3D-1) to 250 mL (3D-3) (P < 0.05). Lymph node yield, positive margin rates, and major complications remained stable. Subjective comfort and coordination scores improved steadily across the 3D groups (both P < 0.001) and correlated negatively with pelvic-phase time (rs = -0.68, P < 0.001).
Conclusions:
Transitioning from 2D to 3D LRC involves a distinct learning curve of about 30 cases. Once visuomotor recalibration is achieved, operative efficiency and intraoperative safety improve substantially without compromising pathological quality. These findings offer an evidence-based framework for structured training and technology adoption in complex pelvic oncology.
