Objectives: The purpose of this study was to determine the effect of three-dimensional (3D) versus two-dimensional
(2D) visualization on the amount of force applied to mitral valve tissue during robotics-assisted mitral valve
annuloplasty, and the time to perform the procedure in an ex vivo animal model. In addition, we examined whether these
effects are consistent between novices and experts in robotics-assisted cardiac surgery.
Methods: A cardiac surgery test-bed was constructed to measure forces applied by the da Vinci surgical system
(Intuitive Surgical, Sunnyvale, CA) during mitral valve annuloplasty. Both experts and novices completed roboticsassisted
mitral valve annuloplasty with 2D and 3D visualization.
Results: The mean time for both experts and novices to suture the mitral valve annulus and to tie sutures using 3D
visualization was significantly less than that required to suture the mitral valve annulus and to tie sutures using 2D vision
(p∠0.01). However, there was no significant difference in the maximum force applied by novices to the mitral valve
during suturing (p = 0.3) and suture tying (p = 0.6) using either 2D or 3D visualization.
Conclusion: This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in
robotics-assisted cardiac surgery.
Keywords: Robotics-assisted surgery, visualization, cardiac surgery