3D Telemedicine Outperforms 2D Telemedicine: A Randomized Crossover Trial in Reconstructive Plastic Surgery

Background: A key barrier to adoption of telemedicine is patient preference for in-person consultations. To address this, an immersive 3-dimensional (3D) telemedicine system was codeveloped with patients to improve the realism, quality, and patient experience of remote consultations, and the benefits were assessed in this randomized trial. Methods: Eighty patients were recruited from the Canniesburn Plastic Surgery Unit, UK to a randomized crossover trial of 3D versus 2-dimensional (2D) telemedicine consultations in 2022 and 2023. The primary outcome was presence using the Presence scale, which measured how closely a remote consultation resembled an in-person consultation. Secondary outcomes included the validated Telehealth Usability Questionnaire (TUQ), the Mental Effort Rating Scale, and satisfaction scales. Results: The Presence score for 3D telemedicine was significantly higher than that for 2D telemedicine (P < 0.001). Secondary outcomes also were superior for 3D telemedicine, including TUQ score (P < 0.001), mental effort (P < 0.001), and satisfaction (P < 0.001). Age, deprivation, education, sex, and technology familiarity were not associated with any outcome measures, indicating inclusivity of the 3D technology. Subjective interviews indicated that 3D telemedicine, by virtue of allowing annotation and drawing on the patients’ own 3D model, aided understanding of complex surgery, allowing a more personalized medicine approach in the consent process. Conclusions: 3D telemedicine improves the realism, interaction quality, and experience of remote consultations relative to 2D telemedicine, with significantly higher presence and TUQ scores. Three-dimensional telemedicine more closely mimics reality, which may help overcome barriers to adoption related to patients’ preference for in-person consultations.