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Carrion DM, Baekelandt L, Socarras MR, Brinkman WM, de Oliveira TR, Pini G, de Vries AH, Bujoreanu CE, Silvestri T, Skolarikos A, Petrut B, Veneziano D, Greco F, Alvarez-Maestro M, Sanchez-Salas R, Tourinho-Barbosa RR, Liatsikos E, Somani B, Rivas JG, Zondervan PJ. Development of the European Laparoscopic Intermediate Urological Skills LUSs2 Curriculum: A Delphi Consensus from the European School of Urology. EUR UROL SUPPL 2024; 69:22-50. [PMID: 39314914 PMCID: PMC11416681 DOI: 10.1016/j.euros.2024.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/25/2024] Open
Abstract
Background and objective While programmes such as the European Basic Laparoscopic Urological Skills have made strides in foundational training, a significant gap exists for intermediate and advanced laparoscopy education. Our objective is to develop and validate the European laparoscopic intermediate urological skills (LUSs2) curriculum, which will establish uniformity in the training of urological laparoscopic procedures and facilitate proficiency among practitioners. Methods The study combines a literature review, cognitive task analysis development by a steering group, and a two-round Delphi survey involving international experts in urological laparoscopy. Consensus was defined as agreement of ≥70% among experts. The survey included statements on various laparoscopic procedures, assessed on a Likert scale from 1 (strongly disagree) to 9 (strongly agree). Key findings and limitations The Delphi process achieved consensus on 85% (235/275) of statements, indicating a strong agreement on the curriculum's content. Areas covered include renal hilum dissection, major vessel injury management, enucleation and renorrhaphy, vesicourethral anastomosis, and pyeloplasty. Limitations include the nonsystematic nature of the literature review and potential biases inherent in expert-based consensus methods. Conclusions and clinical implications The LUSs2 curriculum significantly advances the standardised training of laparoscopic urological skills. It offers a detailed, consensus-validated framework that addresses the need for uniformity in surgical education and aims to enhance surgical proficiency and patient care. Patient summary This study presents the development of a new standardised training curriculum for urological laparoscopic surgery. We intend this curriculum to improve the quality of surgical training and ensure high-quality patient care.
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Affiliation(s)
- Diego M. Carrion
- Department of Urology, Torrejon University Hospital, Madrid, Spain
- Universidad Francisco de Vitoria, Madrid, Spain
| | - Loic Baekelandt
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Willem M. Brinkman
- Department of Oncological Urology, University Medical Centrum Utrecht, Utrecht, The Netherlands
| | | | | | - Anna H. de Vries
- Department of Urology, Diakonessenhuis, Utrecht, The Netherlands
| | | | | | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece
| | - Bogdan Petrut
- Department of Urology, Institutul Oncologic Cluj Napoca, District Cluij, Romania
| | | | | | | | | | | | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Paticia J. Zondervan
- Department of Urology, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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Miles DL, Cui D. Creating Virtual Models and 3D Movies Using DemoMaker for Anatomical Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1431:161-175. [PMID: 37644292 DOI: 10.1007/978-3-031-36727-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Three-dimensional (3D) anatomy models have been used for education in health professional schools globally. Virtual technology has become more popular for online teaching since the COVID-19 pandemic. This chapter will describe a project in which a series of virtual anatomical models of organs and structures were developed for educational purposes, and it will describe in detail how to build three-dimensional (3D) movies using DemoMaker. Although setting up the 3D system was complicated and challenging, the process of reconstructing 3D models from radiographic images and the steps of creating animations and 3D movies are exponentially simpler. These efforts require minimal training, thus allowing most people to be able to engage in this modeling process and utilize the moviemaking steps. Amira® software and computed tomographic angiography (CTA) data were used to create 3D models of the lungs, heart, liver, stomach, kidney, etc. The anatomical locations of these structures within the body can be identified and visualized by recording information from multiple CTA slices using volume and surface segmentation. Ultimately, these virtual 3D models can be displayed via dual projectors onto a specialized silver screen and visualized stereoscopically by viewers as long as they wear 3D polarized glasses. Once these 3D movies are created, they can be played automatically on a computer screen, silver screen, 3D system playback screen, and video player, and they can be embedded into PowerPoint lecture slides. Both virtual models and movies are suitable for self-directed learning, face-to-face class teaching, and virtual anatomy education. Model animations and 3D movie displays offer students the opportunities to learn about anatomy and the anatomical positions of organs in the body and their 3D relationships to one another. By observing and studying these 3D models, students have the potential to be able to compartmentalize the anatomical information and retain it at a higher level than students learning corresponding anatomy without similar resources.
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Affiliation(s)
- David L Miles
- School of Graduate Studies in the Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Dongmei Cui
- Department of Advanced Biomedical Education, University of Mississippi Medical Center, Jackson, MS, USA.
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Rysmakhanov M, Yelemessov A, Mussin N, Yessenbayev D, Saparbayev S, Zhakiyev B, Sultangereyev Y. Two- and three-dimensional laparoscopic donor nephrectomy: a comparative study of a single-center experience. KOREAN JOURNAL OF TRANSPLANTATION 2022; 36:104-110. [PMID: 35919198 PMCID: PMC9296978 DOI: 10.4285/kjt.22.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/05/2022] Open
Abstract
Background This is the first report on three-dimensional (3D) laparoscopic donor nephrectomy performed in the Central Asian region and Commonwealth of Independent States countries. This study presents the results of our initial experiences of 3D hand-assisted laparoscopic donor nephrectomy (3D-HALDN) in comparison with the outcomes of two-dimensional hand-assisted laparoscopic donor nephrectomy (2D-HALDN) at a single center. Methods From 2015 to 2019, 19 3D-HALDN and 19 2D-HALDN procedures were performed at the same center by two surgeons. All 38 procedures used identical techniques. Between-group differences were considered statistically significant at P<0.05. Results The baseline characteristics in both groups were statistically comparable (P>0.05). All donors underwent left nephrectomy. Donors who underwent 3D-HALDN had better outcomes than those who underwent 2D-HALDN, as shown by a shorter warm ischemic time (P<0.05), a shorter operative time (P<0.05), and less blood loss (P<0.05). There were no conversions or major complications (according to the Clavien-Dindo classification) in either group. The average drainage duration and postoperative hospitalization were significantly shorter in the 3D-HALDN group (P<0.05). The between-group differences in the mean postoperative creatinine level and glomerular filtration rate were not significant. Conclusions The 3D-HALDN approach is more beneficial than traditional 2D-HALDN by providing a shorter warm ischemic time, less blood loss, and shorter durations of drainage and postoperative hospitalization. Postoperative complications and the functional condition of the kidney in donors in the early and late postoperative periods did not depend on the type of laparoscopic donor nephrectomy.
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Affiliation(s)
- Myltykbay Rysmakhanov
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
- Department of Surgery and Organ Transplantation, Aktobe Medical Center, Aktobe, Kazakhstan
| | - Asset Yelemessov
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
- Department of Surgery and Organ Transplantation, Aktobe Medical Center, Aktobe, Kazakhstan
| | - Nadiar Mussin
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Daulet Yessenbayev
- Department of Surgical Disease, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Samat Saparbayev
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Bazylbek Zhakiyev
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Yerlan Sultangereyev
- Department of Surgery and Organ Transplantation, Aktobe Medical Center, Aktobe, Kazakhstan
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Tan Q, Yang Y, Yao Y, Yang N, Jin L, Hu X, Xu X, Wang Z, Yang J, Zheng J. Development and Validation of a Homemade and Low-Cost Three-Dimensional Laparoscopic Simulator for Novices. J Laparoendosc Adv Surg Tech A 2022; 32:1071-1077. [PMID: 35467968 DOI: 10.1089/lap.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of this study was to design a low-cost three-dimensional (3D) laparoscopic simulator and validate its training effectiveness. Materials and Methods: We designed a low-cost 3D laparoscopic simulator using magnifying glass and cardboard box. Thirty-two laparoscopic novices were randomly divided into 3D group and two-dimensional (2D) group. The 3D group was trained on 3D simulator four times with 24 hours interval, and the 2D group was trained on 2D simulator. Five standardized laparoscopic tasks were performed by novices in each training. In the second part, subjects were transferred to the opposite simulator for one test after 24 hours of the fourth training. The completing time and errors for each task were recorded to assess the construct validity of simulator. Finally, the face validity and the content validity were evaluated through a closed-ended questionnaire. Results: There was no significant difference between the two groups in demographic or psychometric variables (P > .05). Compared with the 2D group, novices using 3D simulator had a better performance in five laparoscopic tasks, including a faster completing time (P < .001) and lower errors during training (P < .05). Additionally, the increased laparoscopic skill involved with our 3D simulator could be transferred to subsequent performance in 2D simulator (P < .05). Meanwhile, the score of face validity and content validity in our 3D simulator was significantly higher than that in 2D simulator (P < .05). Conclusion: Our 3D laparoscopic simulator effectively improved laparoscopic skills of novice surgeons, suggesting that the low-cost 3D simulator had satisfactory performance to satisfy requirement for novice training.
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Affiliation(s)
- Qi Tan
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yang Yang
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yanxi Yao
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Nengrui Yang
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Lulu Jin
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Xiangyu Hu
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Xiaolei Xu
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Zhongzheng Wang
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Jixin Yang
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Ji Zheng
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
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Sahm M, Danzer C, Grimm AL, Herrmann C, Mantke R. Must Clinics Replace 2D by 3D Environments for an Efficient Training of Laparoscopic Novices? A Critical Analysis of the Learning Curve for Basic Skills. Front Surg 2022; 8:792107. [PMID: 35111805 PMCID: PMC8801449 DOI: 10.3389/fsurg.2021.792107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Aims Published studies repeatedly demonstrate an advantage of three-dimensional (3D) laparoscopic surgery over two-dimensional (2D) systems but with quite heterogeneous results. This raises the question whether clinics must replace 2D technologies to ensure effective training of future surgeons. Methods We recruited 45 students with no experience in laparoscopic surgery and comparable characteristics in terms of vision and frequency of video game usage. The students were randomly allocated to 3D (n = 23) or 2D (n = 22) groups and performed 10 runs of a laparoscopic “peg transfer” task in the Luebeck Toolbox. A repeated-measures ANOVA for operation times and a generalized linear mixed model for error rates were calculated. The main effects of laparoscopic condition and run, as well as the interaction term between the two, were examined. Results No statistically significant differences in operation times and error rates were observed between 2D and 3D groups (p = 0.10 and p = 0.72, respectively). The learning curve showed a significant reduction in operation time and error rates (both p's < 0.001). No significant interactions between group and run were detected (operation time: p = 0.342, error rates: p = 0.83). With respect to both endpoints studied, the learning curves reached their plateau at the 7th run. Conclusion The result of our study with laparoscopic novices revealed no significant difference between 2D and 3D technology with respect to performance time and the error rate in a simple standardized test. In the future, surgeons may thus still be trained in both techniques.
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Affiliation(s)
- Maik Sahm
- Department of Surgery, Brandenburg Medical School, University Hospital, Brandenburg, Germany
- Department of Surgery, DRK Kliniken Berlin Köpenick, Berlin, Germany
- *Correspondence: Maik Sahm
| | - Clara Danzer
- Department of Surgery, Brandenburg Medical School, University Hospital, Brandenburg, Germany
| | - Alexis Leonhard Grimm
- Department of Surgery, Brandenburg Medical School, University Hospital, Brandenburg, Germany
| | - Christian Herrmann
- Department of Surgery, Brandenburg Medical School, University Hospital, Brandenburg, Germany
| | - Rene Mantke
- Department of Surgery, Brandenburg Medical School, University Hospital, Brandenburg, Germany
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Schlinkmann N, Khakhar R, Picht T, Piper SK, Fekonja LS, Vajkoczy P, Acker G. Does stereoscopic imaging improve the memorization of medical imaging by neurosurgeons? Experience of a single institution. Neurosurg Rev 2021; 45:1371-1381. [PMID: 34550492 PMCID: PMC8976776 DOI: 10.1007/s10143-021-01623-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/24/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
Stereoscopic imaging has increasingly been used in anatomical teaching and neurosurgery. The aim of our study was to analyze the potential utility of stereoscopic imaging as a tool for memorizing neurosurgical patient cases compared to conventional monoscopic visualization. A total of 16 residents and 6 consultants from the Department of Neurosurgery at Charité – Universitätsmedizin Berlin were recruited for the study. They were divided into two equally experienced groups. A comparative analysis of both imaging modalities was conducted in which four different cases were assessed by the participants. Following the image assessment, two questionnaires, one analyzing the subjective judgment using the 5-point Likert Scale and the other assessing the memorization and anatomical accuracy, were completed by all participants. Both groups had the same median year of experience (5) and stereoacuity (≤ 75 s of arc). The analysis of the first questionnaire demonstrated significant subjective superiority of the monoscopic imaging in evaluation of the pathology (median: monoscopic: 4; stereoscopic: 3; p = 0.020) and in handling of the system (median: monoscopic: 5; stereoscopic: 2; p < 0.001). The second questionnaire showed that the anatomical characterization of the pathologies was comparable between both visualization methods. Most participants rated the stereoscopic visualization as worse compared to the monoscopic visualization, probably due to a lack of familiarity with the newer technique. Stereoscopic imaging, however, was not objectively inferior to traditional monoscopic imaging for anatomical comprehension. Further methodological developments and incorporation in routine clinical workflows will most likely enhance the usability and acceptance of stereoscopic visualization.
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Affiliation(s)
- Nicolas Schlinkmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Rutvik Khakhar
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Picht
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material", Charitéplatz 1, 10117, Berlin, Germany
| | - Sophie K Piper
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Lucius S Fekonja
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Peter Vajkoczy
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Gueliz Acker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany.
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Kang ML, Wong CMJ, Tan H, Bohari A, Han TO, Soon Y. A secondary learning curve in 3D versus 2D imaging in laparoscopic training of surgical novices. Surg Endosc 2021; 35:1046-1051. [PMID: 32112254 DOI: 10.1007/s00464-020-07466-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Stereoscopic (3D) imaging can be used to facilitate the learning of basic laparoscopic tasks. Its advantages over traditional endoscopic (2D) imaging include better depth perception and spatial orientation. However, the transition between 3D and 2D imaging systems has not been previously studied. This study compares the acquisition of basic laparoscopic skills in a laparoscopic-naïve population using both imaging systems, and explores the possibility of a secondary learning curve in the transition between systems. METHODS 26 novice learners were randomly allocated into two arms and taught to perform two basic laparoscopic tasks adopted from the fundamentals of laparoscopic surgery (FLS) curriculum, peg transfer (T1) and pattern cutting (T2) using either 2D or 3D imaging systems. These tasks were repeated until proficiency was achieved. Participants in each arm then repeated the tasks in the other viewing system (2D/3D vs 3D/2D). The parameters measured were: (a) time taken to complete the task and (b) number of attempts to achieve proficiency. RESULTS There was a significant shortening of time required to achieve proficiency in T2 using a 3D system (mean difference-in-differences = - 65.4, 95% CI - 103.6 to - 27.2, t(24) = - 3.5, p value = 0.002) but no difference between 2D and 3D imaging systems for T1, a simpler task. Sub-group analysis of T1 and T2 between the 2D/3D and 3D/2D arms showed the presence of a secondary learning curve in the 2D/3D arm for both tasks, (T1: β-estimate - 2.68, 95% CI - 3.68 to - 1.68, p value = 0.0003; T2: β-estimate - 2.45, 95% CI - 3.75 to - 1.14, p value 0.004), but in the 3D/2D arm there was a secondary learning curve only for T2. (β-estimate 2.60, 95% CI 1.45-3.76, p value 0.001) CONCLUSION: 3D imaging can be an effective tool to speed the acquisition of proficiency in basic laparoscopic tasks for novice learners, especially in more complex tasks such as pattern cutting. The skills learned in 3D imaging can translate into 2D, albeit with a secondary learning curve.
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Affiliation(s)
- Min Li Kang
- Department of General Surgery, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Chiew Meng Johnny Wong
- Clinical Research Unit, Ng Teng Fong General Hospital, Jurong Health Services, Singapore, Singapore
| | - Hiangjin Tan
- Department of General Surgery, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Azri Bohari
- Department of General Surgery, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Tun Oo Han
- Clinical Research Unit, Ng Teng Fong General Hospital, Jurong Health Services, Singapore, Singapore
| | - Yuen Soon
- Department of General Surgery, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, Singapore, 609606, Singapore.
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Sánchez-Margallo FM, Durán Rey D, Serrano Pascual Á, Mayol Martínez JA, Sánchez-Margallo JA. Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis. J Endourol 2021; 35:123-137. [PMID: 32799686 DOI: 10.1089/end.2020.0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. Methods: A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. Results: A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Conclusions: Three-dimensional laparoscopic systems essentially advance surgical performance in less-experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.
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Affiliation(s)
| | - David Durán Rey
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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Comparative Analysis of Three-Versus Two-dimensional Imaging in Laparoscopic Cholecystectomy. World J Surg 2021; 45:1370-1375. [PMID: 33475802 DOI: 10.1007/s00268-020-05934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Three-dimensional (3D) imaging has been suggested to improve learning and performance of laparoscopy. We sought to investigate whether 3D imaging could improve the outcomes after laparoscopic cholecystectomy. MATERIALS AND METHODS Two-hundred and forty-one consecutive patients underwent elective or urgent laparoscopic cholecystectomy using 2D (n = 111) and 3D (n = 130) imaging equipments from March 2017 to March 2019 at the Kainuu Central Hospital, Finland. The main outcomes of this study were biliary tract injury, conversion to open procedure and procedure duration. RESULTS In the overall series, there were 5 cases of biliary tract injury (2.1%). When compared to 3D imaging, 2D was associated with increased risk of biliary tract injury in the overall series (0% in 3D vs. 4.7% in 2D, p = 0.026) in addition to a subgroup of acute cholecystitis patients operated by senior surgeons (n = 92), 0% in 3D group (n = 60) vs. 10.0% in 2D group (n = 32), p = 0.037 in univariate analysis. The rates of conversion to open surgery did not differ between the groups in the overall series (5.3 vs 5.7%, p = 0.909) or any of the subgroups. Duration of surgery with 3D vs. 2D imaging were comparable in the elective (57.0 ± 16.3 vs. 54.1 ± 18.9 min, p = 0.228) and urgent setting (66.9 ± 15.1 vs. 67.4 ± 16.6 min, p = 0.805). Such differences were not significant in multivariate analysis. CONCLUSIONS The present study suggests that the use of 3D imaging is significantly associated with a reduced risk of intraoperative biliary tract injury during laparoscopic cholecystectomy especially in acute cholecystitis.
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Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, Lai H, Mo X. Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. World J Surg Oncol 2021; 19:23. [PMID: 33478479 PMCID: PMC7819346 DOI: 10.1186/s12957-021-02134-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/13/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The use of 3-dimensional (3D) endoscopic thyroidectomy (ET) has been increasing, but its feasibility and safety have not been well documented for thyroidectomy. Hence, to systematically investigate the comparative outcomes during 3D-ET and 2-dimensional (2D) ET for benign and malignant lesions, we conducted this meta-analysis. METHODS Based on the PRISMA guidelines, a systematic database search of the PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Chinese Wanfang databases was performed. The eligible studies were published in English and Chinese up to October 2020. The major endpoints evaluated were procedure time, blood loss, postoperative drainage, postoperative hospitalization, postoperative complications, total number of lymph node dissections (LNDs), and total cost. RESULTS A total of 15 relevant studies including 1190 patients (583 for 3D-ET and 607 for 2D-ET) compared the application of 3D and 2D laparoscopic systems in thyroid surgery, of which 8 were endoscopic benign thyroidectomy (EBT) and 7 were endoscopic malignant thyroidectomy (EMT). Our meta-analysis indicated that 3D-ET generally had advantages over 2D-ET in terms of procedure time (P = 0.000), blood loss (P = 0.000), postoperative drainage (P = 0.000), postoperative complications (P = 0.000), and LNDs (P = 0.006). However, there were no significant differences between the two systems in terms of total cost (P = 0.245) or postoperative hospitalization (P = 0.068). Subgroup analysis showed consistency of the overall outcomes in each subset, but a shorter postoperative hospitalization in 3D-EBT was revealed. CONCLUSIONS Compared to 2D-ET, 3D endoscopic thyroidectomy is an efficient, safe, and reliable method with better depth perception and stereoscopic vision, and an equally satisfactory outcome. More clinical RCTs with long-term follow-up are required to reproduce these promising results.
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Affiliation(s)
- Zigao Huang
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Haiquan Qin
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Jiankun Liao
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Linghou Meng
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Yongjie Qin
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Baojia Li
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Hao Lai
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Xianwei Mo
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China.
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11
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Tokas T, Avgeris M, Leotsakos I, Nagele U, Gözen AS. Impact of three-dimensional vision in laparoscopic partial nephrectomy for renal tumors. Turk J Urol 2020; 47:144-150. [PMID: 33337319 DOI: 10.5152/tud.2020.20439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare three-dimensional (3D) with standard two-dimensional (2D) laparoscopic partial nephrectomy (LPN) with respect to intra- and postoperative outcomes. MATERIAL AND METHODS Data from 112 patients who underwent transperitoneal LPN from 2012 to 2014 by a single experienced surgeon were collected. Sixty patients (group 1) underwent conventional 2D LPN and 52 patients (group 2) 3D LPN. Perioperative patient, procedure, and tumor data were recorded. The follow-up period was 1-5 years. RESULTS The two groups had similar patient age (p=0.834) and body mass index (p=0.141). The total laparoscopy time (LT) was shorter in group 2 (119.0 vs. 106.0 min; p=0.009). Warm ischemia times (WITs) were also shorter in group 2 (11.5 vs. 10.0 min; p=0.032). The estimated blood loss (EBL) (350.0 vs. 250.0 mL; p<0.001) and hemoglobin (Hb) decrease (1.55 vs. 1.35 g/dL; p=0.536) were lower in the 3D LPN group. Creatinine (0 vs. 0 g/dL; p=0.610) increase and estimated glomerular filtration rate (eGFR) decrease (0 vs. 0 mL/min/1.73 m2; p=0.553) did not demonstrate statistically significant differences. Duration of hospitalization (7 vs. 7 days; p=0.099) and complication rates (p=0.559) were similar between the two groups. CONCLUSION The new-generation 3D laparoscope has a great impact on significant LPN intraoperative parameters, mainly LT, WIT, and EBL. Hb decrease is also in favor of 3D vision, although not dramatically altered. Therefore, 3D LPN appears to be superior to conventional 2D LPNs.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
| | - Ioannis Leotsakos
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
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12
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Bhattacharjee HK, Chaliyadan S, Mishra AK, Agarwal H, Suhani S, Joshi M, Parshad R. Comparison of two-dimensional high-definition, ultra high-definition and three-dimensional endovision systems: an ex-vivo randomised study. Surg Endosc 2020; 35:5328-5337. [PMID: 32959182 DOI: 10.1007/s00464-020-07980-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Two-dimensional high-definition (2D HD) endovision system is preferred for laparoscopic surgery. Recently, new generation three-dimensional (3D) HD and ultra-HD (4K) endovision systems are introduced to improve the safety and efficacy of laparoscopic surgery. There is limited evidence on superiority of one technology over the others. This experimental trial was designed to evaluate 2D HD, 3D HD and 4K HD endovision systems in performance of standardized tasks. METHODS This was a randomized, cross-over experimental study. Twenty-one surgical residents who were exposed to laparoscopic surgery were enrolled. Participants were randomly assigned into three groups. Each group performed standardised tasks i.e. peg transfer, precision cutting, navigating in space and intra-corporeal suturing using 2D HD, 4K HD and 3D HD endovision systems on a box trainer. Procedures were recorded as 2D HD videos and analysed later. Participant's perceived workload was assessed using Surg-TLX questionnaire. Primary endpoints were execution time in seconds and error score. Secondary endpoint was workload assessment. RESULTS The 3D HD had shorter execution time compared to 2D HD and 4K HD in all tasks except precision cutting (p = 0.004, 0.03, 0.001, 0.001 and p = 0.002, 0.191, 0.006, 0.005 in peg transfer, precision cutting, navigating in space and intra-corporeal suturing respectively). The 4K HD was significantly faster than 2D HD only in navigating in space task (p = 0.002). The error score between 3D HD and 4K HD were comparable in all tasks. The 2D HD had significantly more error scores compared to 4K HD, 3D HD in peg transfer task (p = 0.005, 0.014, respectively). 3D HD had significantly less workload than 2D HD and 4K HD in most of the dimensions of Surg-TLX CONCLUSIONS: 3D HD endovision system in comparison to 2D HD and 4K HD, may lead to faster execution without compromising safety of a task and is associated with less workload.
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Affiliation(s)
- Hemanga K Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Shafneed Chaliyadan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ashwani K Mishra
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Harshit Agarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Suhani Suhani
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Mohit Joshi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajinder Parshad
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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13
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Rodríguez-Hermosa JI, Ranea A, Delisau O, Planellas-Giné P, Cornejo L, Pujadas M, Codony C, Gironès J, Codina-Cazador A. Three-dimensional (3D) system versus two-dimensional (2D) system for laparoscopic resection of adrenal tumors: a case-control study. Langenbecks Arch Surg 2020; 405:1163-1173. [PMID: 32909079 DOI: 10.1007/s00423-020-01950-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Laparoscopy is the standard technique for resecting adrenal tumors worldwide. The main drawbacks of conventional 2D laparoscopy are limited depth perception and tactile feedback. Currently available high-quality 3D laparoscopy systems might improve surgical outcomes for adrenalectomy. We compare the safety and efficacy of 3D versus 2D laparoscopy in the treatment of adrenal tumors. METHODS This case-control study analyzed prospectively collected data from patients with benign or malignant adrenal tumors treated laparoscopically at a single academic medical center between April 2003 and March 2020. We collected demographic, diagnostic, preoperative, and operative variables, and used multiple linear and logistic regression to analyze differences in various short-term outcomes between the two approaches while adjusting for potential confounders. RESULTS We included 150 patients: 128 with benign tumors and 22 with malignant tumors; 95 treated with 3D laparoscopy (case group); and 55 with 2D laparoscopy (control group). After adjustment for patient, surgical, and tumor characteristics, a 2D vision was associated with a longer operative time (β = 0.26, p = 0.002) and greater blood loss (β = 0.20, p = 0.047). There was no significant difference in rates of conversion to open surgery (odds ratio [OR] = 1.47 (95% CI 0.90-22.31); p = 0.549) or complications (3.6% vs. 2.1%; p = 0.624). CONCLUSIONS With experienced surgeons, laparoscopic adrenalectomy was safer and more feasible with the 3D system than with the 2D system, resulting in less operative blood loss and shorter operative time with no differences in rates of conversion to open surgery or postoperative complications. For adrenal tumors, 3D laparoscopy offers advantages over 2D laparoscopy.
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Affiliation(s)
- José Ignacio Rodríguez-Hermosa
- Endocrine Surgery Unit, Dr. Josep Trueta University Hospital, Girona, Spain. .,Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain. .,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain. .,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.
| | - Alejandro Ranea
- Endocrine Surgery Unit, Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Olga Delisau
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Pere Planellas-Giné
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Lídia Cornejo
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Marcel Pujadas
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Clara Codony
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Jordi Gironès
- Endocrine Surgery Unit, Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Antoni Codina-Cazador
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
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14
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Abbas AE. Commentary: Stereothoracoscopic Lobectomy. One More Step Toward Surgical Augmented Reality. Semin Thorac Cardiovasc Surg 2020; 32:1097-1098. [PMID: 32846230 DOI: 10.1053/j.semtcvs.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital and Fox Chase Comprehensive Cancer Center, Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
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15
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Large-Field-of-View Visualization with Small Blind Spots Utilizing Tilted Micro-Camera Array for Laparoscopic Surgery. MICROMACHINES 2020; 11:mi11050488. [PMID: 32397580 PMCID: PMC7281158 DOI: 10.3390/mi11050488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
Existing laparoscopic surgery systems use a single laparoscope to visualize the surgical area with a limited field of view (FoV), necessitating maneuvering the laparoscope to search a target region. In some cases, the laparoscope needs to be moved from one surgical port to another one to detect target organs. These maneuvers would cause longer surgical time and degrade the efficiency of operation. We hypothesize that if an array of cameras can be deployed to provide a stitched video with an expanded FoV and small blind spots, the time required to perform multiple tasks at different sites can be significantly reduced. We developed a micro-camera array that can enlarge the FoV and reduce blind spots between the cameras by optimizing the angle of cameras. The video stream of this micro-camera array was designed to be processed in real-time to provide a stitched video with the expanded FoV. We mounted this micro-camera array to a Fundamentals of Laparoscopic Surgery (FLS) laparoscopic trainer box and designed an experiment to validate the hypothesis above. Surgeons, residents, and a medical student were recruited to perform a modified bean drop task, and the completion time was compared against that measured using a traditional single-camera laparoscope. It was observed that utilizing the micro-camera array, the completion time of the modified bean drop task was 203±55 s while using the laparoscope, the completion time was 245±114 s, with a p-value of 0.00097. It is also observed that the benefit of using an FoV-expanded camera array does not diminish for subjects who are more experienced. This test provides convincing evidence and validates the hypothesis that expanded FoV with small blind spots can reduce the operation time for laparoscopic surgical tasks.
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16
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Dirie NI, Wang Q, Wang S. Two-Dimensional Versus Three-Dimensional Laparoscopic Systems in Urology: A Systematic Review and Meta-Analysis. J Endourol 2019; 32:781-790. [PMID: 29969912 PMCID: PMC6156697 DOI: 10.1089/end.2018.0411] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the three-dimensional (3D) laparoscopic system in comparison with two-dimensional (2D) laparoscopy for treatment of different urological conditions. METHODS Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in Web of Science, PubMed, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2018. Articles published in the English language of both randomized and observational studies comparing 3D and 2D laparoscopic systems in urological surgeries were included. Level of evidence and quality assessments of all included studies were conducted. Interested data were extracted for comparison and meta-analysis. RESULTS Our literature search generated 17 studies comparing 3D and 2D laparoscopic systems in different urological surgeries. Of these, 13 studies containing 548 and 449 patients operated on with 2D and 3D laparoscopic systems, respectively, were included for meta-analysis. These 13 studies were divided into three groups according to surgical type. Group 1: Partial nephrectomy (PN); operative time (p = 0.19), estimated blood loss (EBL) (p = 0.51), dissecting time (p = 0.58), and suturing time (p = 0.28) were not statistically significant between 2D and 3D laparoscopic systems. However, warm ischemia time during PN was significantly shorter during 3D laparoscopy (p < 0.00001). Group 2: Pyeloplasty; this procedure showed no significant difference between the two systems. Group 3: Radical prostatectomy (RP); shorter operative time (p < 0.0001) and lower EBL (p = 0.001) were associated with the 3D laparoscopic system. CONCLUSION Three-dimensional laparoscopy mainly improves the depth of perception, leading to better visibility, which is important for some complex urological surgeries such as PN, pyeloplasty, and RP. Based on our findings, 3D laparoscopy seems to provide better clinical and surgical outcomes in some urological procedures compared with conventional 2D laparoscopy.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
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17
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Anatomy Visualizations Using Stereopsis: Current Methodologies in Developing Stereoscopic Virtual Models in Anatomical Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019. [PMID: 31338777 DOI: 10.1007/978-3-030-19385-0_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Technology for developing three-dimensional (3D) virtual models in anatomical sciences education has seen a great improvement in recent years. Various data used for creating stereoscopic virtual models have also been constantly improving. This paper focuses specifically on the methodologies of creating stereoscopic virtual models and the techniques and materials used in developing stereoscopic virtual models from both our previous studies and other published literature. The presentation and visualization of stereoscopic models are highlighted, and the benefits and limitations of stereoscopic models are discussed. The practice of making 3D measurements on the lengths, angles, and volumes of models can potentially be used to help predict typical measurement parameters of anatomical structures and for the placement of surgical instruments. Once stereoscopic virtual models have been constructed, their visualization and presentation can be implemented in anatomy education and clinical surgical trainings.
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18
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Wehr F, Held J. Stereoscopic versus monoscopic displays: Learning fine manual dexterity skills using a microsurgical task simulator. APPLIED ERGONOMICS 2019; 77:40-49. [PMID: 30832777 DOI: 10.1016/j.apergo.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/18/2018] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
We investigated the learning of fine manual dexterity with a microsurgical instrument and a new simulator in a context of microsurgery. 30 subjects were divided into two groups. One (3D group) interacted with a stereoscopic and the other (2D group) with a monoscopic display. Visual information for the displays was captured from a surgical stereomicroscope. In 20 trials, both groups performed the repetitive tasks of picking up small rods from a funnel-shaped cavity and placing them outside. In analysing learning curves, we found that the initial learning process for hand-eye coordination is easier with a 3D display, and that performance persists at a higher level of proficiency than with the 2D display option. Thus stereoscopic displays can be especially beneficial for novices, for those learning new procedures, or for providing orientation to operators facing a new or altered spatial situation. Simulators with few reliefs or spatial textures should not be used for comparison between 3D and 2D viewing conditions.
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Affiliation(s)
- Franka Wehr
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
| | - Jürgen Held
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
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19
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Wang T, Zheng B. 3D presentation in surgery: a review of technology and adverse effects. J Robot Surg 2018; 13:363-370. [PMID: 30847653 DOI: 10.1007/s11701-018-00900-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/02/2018] [Indexed: 01/15/2023]
Abstract
A systematic review was undertaken to assess the technology used to create stereovision for human perception. Adverse effects associated with artificial stereoscopic technology were reviewed with an emphasis on the impact of surgical performance in the operating room. MEDLINE/PubMed library databases were used to identify literature published up to Aug 2017. In the past 60 years, four major types of technologies have been used for reconstructing stereo images: anaglyph, polarization, active shutter, and autostereoscopy. As none of them can perfectly duplicate our natural stereoperception, user exposure to this artificial environment for a period of time can lead to a series of psychophysiological responses including nausea, dizziness, and others. The exact mechanism underlying these symptoms is not clear. Neurophysiologic evidences suggest that the visuo-vestibular pathway plays a vital role in coupling unnatural visual inputs to autonomic neural responses. When stereoscopic technology was used in surgical environments, controversial results were reported. Although recent advances in stereoscopy are promising, no definitive evidence has yet been presented to support that stereoscopes can enhance surgical performance in image-guided surgery. Stereoscopic technology has been rapidly introduced to healthcare. Adverse effects to human operators caused by immature technology seem inevitable. The impact on surgeons working with this visualization system needs to be explored and its safety and feasibility need to be addressed.
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Affiliation(s)
- Tianqi Wang
- Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 162 Heritage Medical Research Centre, 112 St. NW, Edmonton, AB, T6G 2E1, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 162 Heritage Medical Research Centre, 112 St. NW, Edmonton, AB, T6G 2E1, Canada.
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20
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The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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21
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Arezzo A, Vettoretto N, Francis NK, Bonino MA, Curtis NJ, Amparore D, Arolfo S, Barberio M, Boni L, Brodie R, Bouvy N, Cassinotti E, Carus T, Checcucci E, Custers P, Diana M, Jansen M, Jaspers J, Marom G, Momose K, Müller-Stich BP, Nakajima K, Nickel F, Perretta S, Porpiglia F, Sánchez-Margallo F, Sánchez-Margallo JA, Schijven M, Silecchia G, Passera R, Mintz Y. The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018; 33:3251-3274. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Nereo Vettoretto
- Montichiari Surgery, ASST Spedali Civili Brescia, Montichiari, Italy
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | - Marco Augusto Bonino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Nathan J Curtis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK.,Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - Daniele Amparore
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Manuel Barberio
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Ronit Brodie
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Thomas Carus
- Department of Surgery, Center for Minimally Invasive Surgery, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - Enrico Checcucci
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Petra Custers
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Marilou Jansen
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Joris Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gadi Marom
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kota Momose
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Beat P Müller-Stich
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Kyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Felix Nickel
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Silvana Perretta
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Francesco Porpiglia
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | | | | | - Marlies Schijven
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Passera
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Yoav Mintz
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Abstract
BACKGROUND The 3D laparoscopy is currently under intensive discussion. At the moment the majority of newly acquired laparoscopy systems include the 3D technique. New 4K systems, which will be offered in combination with 3D, are complicating the decision-making when buying new laparoscopic systems. The aim of the article is to show the advantages and possible limitations of 3D laparoscopy. Furthermore, the position of 3D laparoscopy in the current video market is evaluated. MATERIAL AND METHODS This study was based on an up to date literature search in PubMed. Concerning the question whether the 3D is replacing the 2D laparoscopy, observations from the industry and a personal evaluation were included in the analysis. RESULTS The current studies show clear advantages of 3D laparoscopy concerning operation time, efficiency and workload. A major proportion of the studies were conducted on simulation trainers; however, some clinical trials also confirmed these results. The learning curve in laparoscopic surgery is clearly improved with the 3D technique and 3D also seems be useful for operations by experts. The limitation is that not every surgeon can see three dimensionally. Furthermore, the set-up in the operation room needs to be optimized so that a 3D system can be successfully implemented with the nursing staff and side effects, such as exhaustion, dizziness or headache can be prevented. CONCLUSION The choice of video system will depend on the personal interest of the surgeon and the ability to see 3D. It can be assumed that the majority of the systems will include 3D laparoscopy but 2D laparoscopy will not be completely replaced. A dynamic development of 3D in association with 4K and robotics can be expected.
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Affiliation(s)
- A Buia
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Asklepios Kliniken Langen, Röntgenstr. 20, 63225, Langen, Deutschland
| | - S Farkas
- Klinik für Allgemein- und Viszeralchirurgie, St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189, Wiesbaden, Deutschland.
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Intraoperative utilization of advanced imaging modalities in a complex kidney stone case: a pilot case study. World J Urol 2018; 36:733-743. [DOI: 10.1007/s00345-018-2260-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/07/2018] [Indexed: 10/17/2022] Open
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24
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Illumination in Spinal Surgery Depending on Different Approaches and Light Sources. World Neurosurg 2017; 105:585-590. [PMID: 28602930 DOI: 10.1016/j.wneu.2017.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sufficient visualization of the operating field is crucial for success in surgery and is important especially concerning minimally invasive and deep approaches in spine surgery. METHODS The spinal microsurgical approach was imitated using an isolated box that was accessed with different devices. Different light sources and auxiliary devices were analyzed and compared. Light sources used were a microscope, a standard operating room lamp, and a headlamp. The auxiliary devices included different tubes with and without optical light fibers, different retractors, and an endoscope. RESULTS We demonstrated that different combinations of light sources and auxiliary devices provide significantly different illumination in the artificial operating field. A tube with optical fibers seems to be superior for nonmicroscopic approaches. The smaller these tubes are in diameter, the higher the illuminance on the surgical focus. CONCLUSIONS The combination of tube and microscope seems to be the best choice for deep approaches in microsurgical spinal surgery. An endoscope supplies illuminance comparable to a surgical microscope.
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25
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Hagelsteen K, Langegård A, Lantz A, Ekelund M, Anderberg M, Bergenfelz A. Faster acquisition of laparoscopic skills in virtual reality with haptic feedback and 3D vision. MINIM INVASIV THER 2017; 26:269-277. [DOI: 10.1080/13645706.2017.1305970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Kristine Hagelsteen
- Practicum Clinical Skills Center, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Langegård
- Practicum Clinical Skills Center, Skåne University Hospital, Lund, Sweden
| | - Adam Lantz
- Practicum Clinical Skills Center, Skåne University Hospital, Lund, Sweden
| | - Mikael Ekelund
- Practicum Clinical Skills Center, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Anderberg
- Practicum Clinical Skills Center, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Bergenfelz
- Practicum Clinical Skills Center, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
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26
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Sørensen SMD, Mahmood O, Konge L, Thinggaard E, Bjerrum F. Laser visual guidance versus two-dimensional vision in laparoscopy: a randomized trial. Surg Endosc 2016; 31:112-118. [PMID: 27317036 PMCID: PMC5216078 DOI: 10.1007/s00464-016-4937-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/09/2016] [Indexed: 12/04/2022]
Abstract
Background During laparoscopy, the surgeon’s loss of depth perception and spatial orientation is problematic. Laser visual guidance (LVG) is an innovative technology that improves depth perception to enhance the visual field. In this trial, we examined the effect of LVG on surgical novices’ motor skills, quality of task performance, and cognitive workload. Methods We designed a randomized controlled trial following the CONSORT statement. Thirty-two surgical novices completed the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test. The first attempt allowed participants to familiarize themselves with the exercises. We then randomized the participants, and they completed a test session using either LVG or conventional two-dimensional vision. Results We found no significant difference between using the LVG tool and conventional 2D vision; however, both the mean completion time and movements used were less in the LVG group: Mean time used in the LVG group was 1288 s (95 % CI 1188–1388) versus 1354 s (95 % CI 1190–1518) (p = 0.45); mean angular path length used in the LVG group was 24,049° (95 % CI 20,761–27,336) versus 26,014° (95 % CI 22,059–29,970) (p = 0.42); mean path length in the LVG group was 4560 cm (95 % CI 3971–5,149 cm) versus 5062 cm (95 % CI 4328–5797), (p = 0.26). Moreover, the mean TABLT performance score was higher in the LVG group compared with the 2D group, although not significant: 379 (95 % CI 352–405) versus 338 (95 % CI 288–387) (p = 0.14). No significant difference was found between the groups’ cognitive workloads. Conclusion We found no significant improvement of laparoscopic motor skills when using LVG, although a tendency toward improved performance was seen. LVG could have the potential to help novice surgeons acquire basic laparoscopic; however, further development of the concept and validation is needed to confirm this.
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Affiliation(s)
- Stine Maya Dreier Sørensen
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark. .,University of Copenhagen, Copenhagen, Denmark.
| | - Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Ebbe Thinggaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - Flemming Bjerrum
- University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
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