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Gibson EA. Augmenting Veterinary Minimally Invasive Surgery: Evidence-based Review of Foundational and Novel Devices and Technology. Vet Clin North Am Small Anim Pract 2024; 54:721-733. [PMID: 38519369 DOI: 10.1016/j.cvsm.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Veterinary minimally invasive surgery continues to grow as a specialty. With increasing experience in this field, comes improved accessibility as well as progressive complexity of procedures performed. Advancement in technology has been both a response to the growth and a necessary driver of continued refinement of this field. Innovative research leading to advancements in surgical equipment has led to the development of novel image acquisition platforms, cannulas, smoke evacuation systems, antifog devices, instrumentation, and ligating/hemostatic devices. These innovations will be reviewed and potential clinical applications are discussed.
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Affiliation(s)
- Erin A Gibson
- University of Pennsylvania, Matthew J. Ryan Veterinary Hospital, Department of Clinical Sciences and Advanced Medicine, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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Tercan C, Sivas MC, Aktoz F. The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study. Arch Gynecol Obstet 2024; 309:1027-1033. [PMID: 38184803 DOI: 10.1007/s00404-023-07335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE 2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. METHODS In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. RESULTS The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). CONCLUSION In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.
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Affiliation(s)
- Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Mustafa Can Sivas
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Fatih Aktoz
- Women's Health Center, American Hospital, Istanbul, Turkey
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Shuai H, Duan X, Wu T. Comparison of perioperative, oncologic, and functional outcomes between 3D and 2D laparoscopic radical prostatectomy: a systemic review and meta-analysis. Front Oncol 2023; 13:1249683. [PMID: 37795432 PMCID: PMC10546177 DOI: 10.3389/fonc.2023.1249683] [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] [Received: 06/29/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Objectives Literature regarding experience with 3D laparoscopy about prostatectomy has remained scanty, and this could be related to the rise of robotic assisted laparoscopic surgery. This study aimed to perform a systemic review and meta-analysis to evaluate the perioperative, functional, and oncologic outcomes between 3D and 2D laparoscopic radical prostatectomy (LRP). Methods We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared perioperative, functional, or oncologic outcomes of both 3D and 2D LRP. The Newcastle-Ottawa Scale (NOS) tool and Jadad scale were used to assess the risk of bias in the included studies. Review Manager 5.3 was used for the meta-analysis. Results Seven studies with a total of 542 patients were included in the analysis. Among them, two were RCTs. There was no difference between groups in terms of preoperative characteristics. Anastomosis time, hospital day, and overall complication rates were similar in 3D than 2D group. However, operative time [mean difference (MD) -36.96; 95% confidence interval [CI] -59.25 to -14.67; p = 0.001], blood loss (MD -83.5; 95% CI -123.05 to -43.94; p <0.0001), and days of drainage (MD -1.48; 95% CI -2.29 to -0.67; p = 0.0003) were lower in 3D LRP. 2D and 3D LRP showed similarity in the positive surgical margin (PSM) rate and biochemical recurrence (BCR) rate at 3, 6, and 12months postoperatively. Additionally, there was no significant differences in continence and potency recovery rate between two group except higher continence rate of 3D LRP at 3 months. Conclusion Current evidence shows that 3D LRP offers favorable outcomes compared with 2D LRP, including operative time, blood loss, days of drainage, and early continence. However, there was no conclusive evidence that 3D LRP was advantaged in terms of oncologic and functional outcomes (except for continence rate at 3 months). Systematic review registration The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023426403).
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Affiliation(s)
- Hui Shuai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xi Duan
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Kanamori K, Koyanagi K, Ozawa S, Oguma J, Kazuno A, Ninomiya Y, Yamamoto M, Shoji Y, Yatabe K, Mori M. Usefulness of three-dimensional thoracoscope for prone position thoracoscopic esophagectomy improves mediastinal lymph node dissection and prognosis for esophageal cancer. Cancer Rep (Hoboken) 2023; 6:e1850. [PMID: 37339941 PMCID: PMC10432463 DOI: 10.1002/cnr2.1850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/12/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES This study aimed to assess the superiority of 3D flexible thoracoscope against 2D thoracoscope for lymph node dissection (LND) and prognosis for prone-position thoracoscopic esophagectomy (TE) in esophageal cancer. METHODS Three hundred and sixty-seven esophageal cancer patients who underwent prone-position TE with 3-field LND between 2009 and 2018 were evaluated. 2D and 3D thoracoscope was used in 182 (2D group) and 185 cases (3D group), respectively. Short-term surgical outcomes, numbers of retrieved mediastinal lymph node (LN), and rates of LN recurrence were compared. Risk factors for mediastinal LN recurrence and long-time prognosis were also evaluated. RESULTS No differences in postoperative complications were observed between the groups. The numbers of retrieved mediastinal LN were significantly higher, and the rates of LN recurrence were significantly lower in the 3D group compared to 2D group. Use of 2D thoracoscope was a significant independent factor of middle mediastinal LN recurrence by multivariable analysis. Survival was compared by cox regression analysis, and the 3D group had a significantly better prognosis than the 2D group. CONCLUSIONS Prone position TE using 3D thoracoscope may improve the accuracy of mediastinal LND and prognosis without increasing postoperative complications for esophageal cancer.
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Affiliation(s)
- Kohei Kanamori
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Kazuo Koyanagi
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Soji Ozawa
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Junya Oguma
- Department of Esophageal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Akihito Kazuno
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Yamato Ninomiya
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Miho Yamamoto
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Yoshiaki Shoji
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Kentaro Yatabe
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Masaki Mori
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
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Portale G, Spolverato YC, Tonello AS, Bartolotta P, Frigo G, Simonetto M, Gregori D, Fiscon V. Which video technology brings the higher cognitive burden and motion sickness in laparoscopic colorectal surgery: 3D, 2D-4 K or 3D-4 K? a propensity score study. Int J Colorectal Dis 2023; 38:190. [PMID: 37428283 DOI: 10.1007/s00384-023-04491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Technological development has offered laparoscopic colorectal surgeons new video systems to improve depth perception and perform difficult task in limited space. The aim of this study was to assess the cognitive burden and motion sickness for surgeons during 3D, 2D-4 K or 3D-4 K laparoscopic colorectal procedures and to report post-operative data with the different video systems employed. METHODS Patients were assigned to either 3D, 2D-4 K or 3D-4 K video and two questionnaires (Simulator Sickness Questionnaire-SSQ- and NASA Task Load Index -TLX) were used during elective laparoscopic colorectal resections (October 2020-August 2022) from two operating surgeons. Short-term results of the operations performed with the three different video systems were also analyzed. RESULTS A total of 113 consecutive patients were included: 41 (36%) in the 3D Group (A), 46 (41%) in the 3D-4 K Group and 26 (23%) in the 2D-4 K Group (C). Weighted and adjusted regression models showed no significant difference in cognitive load amongst the surgeons in the three groups of video systems when using the NASA-TLX. An increased risk for slight/moderate general discomfort and eyestrain in the 3D-4 K group compared with 2D-4 K group (OR = 3.5; p = 0.0057 and OR = 2.8; p = 0.0096, respectively) was observed. Further, slight/moderate difficulty focusing was lower in both 3D and 3D-4 K groups compared with 2D-4 K group (OR = 0.4; p = 0.0124 and OR = 0.5; p = 0.0341, respectively), and higher in the 3D-4 K group compared with 3D group (OR = 2.6; p = 0.0124). Patient population characteristics, operative time, post-operative staging, complication rate and length of stay were similar in the three groups of patients. CONCLUSIONS 3D and 3D-4 K systems, when compared with 2D-4 K video technology, have a higher risk for slight/moderate general discomfort and eyestrain, but show lower difficulty focusing. Short post-operative outcomes do not differ, whichever imaging system is used.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40; 35013, Cittadella, Padua, Italy.
| | - Ylenia Camilla Spolverato
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40; 35013, Cittadella, Padua, Italy
| | | | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Gianfranco Frigo
- Department of Cardiology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Marco Simonetto
- Department of Neurology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40; 35013, Cittadella, Padua, Italy
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Portale G, Marconato R, Pedon S, Bartolotta P, Gregori D, Morabito A, Sava T, Fiscon V. Does 3D laparoscopic video technology affect long-term survival in right hemicolectomy for cancer compared to standard 2D? A propensity score study. Int J Colorectal Dis 2023; 38:6. [PMID: 36625957 DOI: 10.1007/s00384-022-04297-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND There are few studies focused on the short-term results of laparoscopic right hemicolectomy performed with 2D (two-dimension) or 3D (three-dimension) video technology and none on the oncologic effects. The aim of the study was to assess the long-term results of laparoscopic right hemicolectomy (LRH) with intracorporeal anastomosis using 3D or 2D video in patients with right colon cancer with at least three years of oncologic follow-up. METHODS Data from patients undergoing laparoscopic right hemicolectomy (LRH) with intracorporeal anastomosis for cancer in an 11-year period (June 2008-June 2019) and ≥ 3 years of follow-up were prospectively collected. Surgical procedures were performed by two expert laparoscopic surgeons. RESULTS 111 patients were included in the study: 56 (50.5%) in the 3D group and 55 (49.5%) in the 2D group. Tumor stage and number of lymph nodes harvested were similar. Overall and disease-free survival were not different in the two groups. Local recurrence occurred in none of the patients, and distant metachronous metastases were similar in the two groups. A propensity score weighting approach was used to account for potential confounding related to patients' nonrandom allocation to the 2 groups. The effects of the intervention on postoperative outcomes were assessed with a weighted regression approach. CONCLUSIONS Laparoscopic 3D technology allows similar oncological results as 2D vision in LRH with intracorporeal anastomosis. Larger prospective randomized studies might confirm these results in the long-term follow-up.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy.
| | - Roberto Marconato
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Sabrina Pedon
- Department of General Surgery, University of Ferrara, Ferrara, Italy
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, 35121, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, 35121, Italy
| | - Alberto Morabito
- Department of Oncology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Teodoro Sava
- Department of Oncology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
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Laparoscopic surgery in 3D improves results and surgeon convenience in sleeve gastrectomy for morbid obesity. Langenbecks Arch Surg 2022; 407:3333-3340. [PMID: 36180641 DOI: 10.1007/s00423-022-02681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/12/2022] [Indexed: 10/07/2022]
Abstract
PURPOSE Advanced laparoscopic procedures are still challenging. One critical issue is the lack of stereoscopic vision. The aim of this surgical study is to evaluate whether 3D vision offers any advantages for surgical performance over 2D vision during sleeve gastrectomy for morbid obesity using a laparoscopic system that allows changing between 2D and 3D optics. METHODS A total of 78 patients were analyzed, with 37 in the 2D group and 41 in the 3D group. Performance time, hospital stay, complications, and early outcomes were collected. To assess the quality of the 2D and 3D techniques, visual analog scales from 0 to 10 were designed, and image quality, depth of field, precision in performing tasks, and general ergonomics were measured. RESULTS According to the vision system used, the mean duration of surgery was 85 ± 16.8 min for patients operated on with the 2D system and 69 ± 16.9 min for those operated on with the 3D system. There were no significant differences between the overall percentages of complications according to the type of vision used. However, postoperative complications were more severe in the 2D laparoscopy group. The average length of stay was shorter for patients in the 3D group. Regarding the differences perceived by the surgeon, the depth of field and the precision of tasks were better in the 3D vision group. CONCLUSION The 3D system provided greater depth perception and precision in more complex tasks, enabling safer surgery. This led to a reduction in the operative time and hospital stay. Moreover, the severity of complications was less.
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Wang Z, Liang J, Chen J, Mei S, Liu Q. Three-Dimensional (3D) Laparoscopy Versus Two-Dimensional (2D) Laparoscopy: A Single-Surgeon Prospective Randomized Comparative Study. Asian Pac J Cancer Prev 2020; 21:2883-2887. [PMID: 33112544 PMCID: PMC7798154 DOI: 10.31557/apjcp.2020.21.10.2883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Visual information is crucial for performing laparoscopic surgery. While surgeons lose depth perception and spatial orientation in conventional 2D laparoscopy, the 4th generation 3D system gives a better depth perception. Objective: In this sstudy, we aimed to investigate the feasibility, safety, and short-term efficacy of 4th generation 3D-HD visualization technology applied in laparoscopic colon cancer surgery. Methods: One hundred and twenty patients with colon adenocarcinoma were recruited in this study. Patients were randomized on the day of surgery by a random computer-generated allocation list to undergo either a 3D-HD display or 2D-HD imaging system laparoscopic colon cancer surgery. In total, 60 patients underwent laparoscopic colon resection by 3D-HD laparoscope (3D group) and 60 patients underwent 2D-HD laparoscope (2D group). After the insertion of the access ports, both surgical procedures were divided in component tasks, and the execution times were compared. Data analysis was done using SPSS (version 15.0). Quantitative and qualitative variables were compared applying Student t test and Pearson’s chi-square test. Results: Two groups were homogenous in terms of demographic data. Operation time was significantly shorter for the 3D group than for the 2D group (123.2±34.2 min vs. 142.2±23.5 min, P=0.018). There was no statistically significant difference between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery, and postoperative complications (P>0.05). Conclusion: The 4th generation 3D-HD vision system reduced the operating time compared to 2D-HD vision system. It seems that use of the 3D-HD technology can significantly enhance the possibility of achieving better intraoperative results.
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Affiliation(s)
- Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianan Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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Portale G, Pedon S, Benacchio L, Cipollari C, Fiscon V. Two-dimensional (2-D) vs. three-dimensional (3-D) laparoscopic right hemicolectomy with intracorporeal anastomosis for colon cancer: comparison of short-term results. Surg Endosc 2020; 35:5279-5286. [PMID: 32940793 DOI: 10.1007/s00464-020-07977-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/09/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND There are few reports comparing safety and efficacy of 2-D and 3-D video technology in laparoscopic right hemicolectomy. The aim of the study was to assess the short-term results of laparoscopic right hemicolectomy (LHR) with intracorporeal anastomosis with 2-D/3-D video in patients with right colon cancer. METHODS Data from 239 patients undergoing LRH for cancer in a 14-year period (June 2005-January 2020) were prospectively collected. Surgical procedures were performed by two expert laparoscopic surgeons. RESULTS One hundred and fourteen patients were included in the study: 55 (48.2%) operated with 2-D and 59 (51.8%) with 3-D video. Tumor site and postoperative stage distribution were similar. Mean operative time was comparable in the two groups (159.0 ± 48.8 min vs. 17.06 ± 36.0 min, p = ns, group 2-D and 3-D, respectively). Group 3-D patients had a similar percentage of associated procedures (44.1% vs. 29.1%, p = ns). Intraoperative complications were nil in both groups, while postoperative complications were similar (30.9% 2-D vs 25.4% 3-D, p = ns). The mean number of lymph nodes retrieved was similar in group 3-D (26.0 ± 14.6 vs. 22.9 ± 9.3, p = ns) and the length of stay was comparable in 3-D and 2-D patients (8.4 ± 2.6 vs. 9.1 ± 3.3 days, respectively, p = ns). CONCLUSIONS Laparoscopic 3-D vision is as equally effective as 2-D vision in LRH with intracorporeal anastomosis, with a similar proportion of associated procedures and number of lymph nodes retrieved in the same operative time. Further prospective larger randomized studies are necessary to verify if LRH with 3-D video can reduce postoperative complications, compared to 2-D video.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Italy.
| | - Sabrina Pedon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Italy
| | - Luca Benacchio
- Department of Epidemiology, Azienda Euganea ULSS 6, Padua, Italy
| | - Chiara Cipollari
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Italy
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Wu J, Zhang G, Yao X, Xiang Y, Lin R, Yang Y, Zhang X. Achilles'heel of laparoscopic pancreatectomy: reconstruction of the remnant pancreas. Expert Rev Gastroenterol Hepatol 2020; 14:527-537. [PMID: 32567383 DOI: 10.1080/17474124.2020.1775582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Laparoscopic pancreatic reconstruction is a challenging procedure and is considered the Achilles' heel of laparoscopic pancreatectomy. Multiple techniques of laparoscopic pancreatic reconstruction have been reported, but the optimal technique remains unclear. AREAS COVERED This paper provides a brief introduction to the developmental status and major related complications of laparoscopic pancreatic reconstruction. We reviewed all published literature on the technology of laparoscopic pancreatic reconstruction within the last 5 years and herein discuss the advantages and disadvantages of different reconstruction methods. We also discuss several details of different reconstruction techniques in terms of their significance to the operation and complications. EXPERT OPINION No individual method of laparoscopic pancreatic reconstruction is considered optimal for all conditions. The reconstruction strategy should be based on the surgeon's proficiency with laparoscopic technology and the patient's individual risk factors. Personalized methods of pancreatic reconstruction may more effectively reduce morbidity and mortality.
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Affiliation(s)
- Jiacheng Wu
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , 130041, Changchun, China, East Asia
| | - Guofeng Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Xiaoxiao Yao
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Yien Xiang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , 130041, Changchun, China, East Asia
| | - Ruixin Lin
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Yongsheng Yang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Xuewen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , 130041, Changchun, China, East Asia
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Cognitive load in 3d and 2d minimally invasive colorectal surgery. Surg Endosc 2020; 34:3262-3269. [PMID: 32239306 DOI: 10.1007/s00464-020-07524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Three-dimensional (3d) laparoscopy has been introduced to enhance depth perception and facilitate surgical operations. The aim of this study was to compare cognitive load during 3d and 2d laparoscopic procedures. METHODS Two subjective questionnaires (the Simulator Sickness Questionnaire and the NASA task load index) were used to prospectively collect data regarding cognitive load in surgeons performing 2d and 3d laparoscopic colorectal resections. Moreover, the perioperative results of 3d and 2d laparoscopic operations were analyzed. RESULTS A total of 313 patients were included: 82 in the 2d group and 231 in the 3d group. The NASA TLX results did not reveal significantly major cognitive load differences in the 3d group compared with the 2d group; the SSQ results were better in the 3d group than in the 2d group in terms of general discomfort, whereas difficulty concentrating, difficulty focusing, and fatigue were more frequent in 3d operations than in 2d operations (p = 0.001-0.038). The results of age, sex, and ASA score were comparable between the two groups (p = 0.299-0.374). The median operative time showed no statistically significant difference between the 3d and 2d groups (median, IQR, 2d 150 min [120-180]-3d 160 min [130-190] p = 0.611). There was no statistically significant difference in the risk of severe complications between patients in the 3d group and in the 2d group (2d 7 [8.54%] vs 3d 21 [9.1%], p = 0.271). The median hospitalization time and the reoperation rate showed no difference between the 2d and 3d operations (p = 0.417-0.843). CONCLUSION The NASA TLX did not reveal a significant difference in cognitive load between the 2d and 3d groups, whereas data reported by the SSQ showed a mild risk of cognitive load in the 3d group. Furthermore, 3d laparoscopic surgery revealed the same postoperative results as 2d standard laparoscopy.
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Zhao B, Lv W, Mei D, Luo R, Bao S, Huang B, Lin J. Comparison of short-term surgical outcome between 3D and 2D laparoscopy surgery for gastrointestinal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 2020; 405:1-12. [PMID: 31970475 DOI: 10.1007/s00423-020-01853-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Three-dimensional (3D) laparoscopic surgery is becoming more popular with the development of laparoscopic devices. The objective of this study was to explore whether the 3D imaging system could improve surgical outcomes of laparoscopic surgery for gastrointestinal cancer compared with the 2D imaging system. METHODS Systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Surgical quality, postoperative complications, and postoperative recovery between 3D and 2D laparoscopic surgery groups were compared using a fixed or random effect model. RESULTS A total of 12 studies involving 1456 patients (3D group 683 patients and 2D group 773 patients) were included in this meta-analysis. The results indicated that mean operation time was significantly shorter in 3D group than in 2D group (WMD, - 9.08; 95% CI, - 14.77, - 3.40; P = 0.002; I2 = 70.3%), especially for gastric cancer patients (WMD, - 14.61; 95% CI, - 26.00, - 3.23, P = 0.012; I2 = 74.1%). In addition, 3D laparoscopic surgery for gastric cancer had an advantage than 2D group in reducing the amount of intraoperative blood loss (WMD, - 13.60, 95% CI, - 21.48, - 5.72; P = 0.001; I2 = 0%). The number of retrieved lymph nodes in 3D group was not significantly different from that in 2D group, regardless of laparoscopic gastrectomy (WMD, 1.10; 95% CI, - 0.67, 2.88; P = 0.222; I2 = 18.8%) and laparoscopic colorectal surgery (WMD, 0.55, 95% CI; - 1.99, 3.09; P = 0.671; I2 = 76.9%). In addition, there was no significant difference between 3D and 2D laparoscopic surgery for postoperative complications and postoperative recovery. CONCLUSION Main advantages of 3D laparoscopic gastrectomy for gastric cancer were that it could shorten the operation time and reduce the amount of intraoperative blood loss. However, 3D laparoscopic surgery had no obvious advantage over 2D laparoscopic surgery for colorectal cancer patients.
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Affiliation(s)
- Bochao Zhao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China.,Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, People's Republic of China
| | - Wu Lv
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, People's Republic of China
| | - Di Mei
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Rui Luo
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, People's Republic of China
| | - Shiyang Bao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Baojun Huang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Jie Lin
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, People's Republic of China.
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Rana AM, Rana AA, Hewett PJ. Comparison of three‐dimensional and 4K imaging systems in novice surgeons: a cross‐over study. ANZ J Surg 2020; 90:1009-1013. [DOI: 10.1111/ans.15653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Abdullah Muhammad Rana
- Department of Colorectal SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Abdul Ahad Rana
- Department of Colorectal SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Peter J. Hewett
- Department of Colorectal SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
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Comparison of 3D endoscopy and conventional 2D endoscopy in gastric endoscopic submucosal dissection: an ex vivo animal study. Surg Endosc 2019; 33:4164-4170. [PMID: 30843096 DOI: 10.1007/s00464-019-06726-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 03/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Conventional endoscopy provides two-dimensional (2D) information without depth information. This study compared three-dimensional (3D) endoscopy and 2D endoscopy using an endoscopic submucosal dissection (ESD) training model to evaluate the utility of 3D endoscopy. METHODS Porcine stomach specimens (7 × 7 cm) were prepared from commercially available resected porcine stomachs and a 10-mm hypothetical lesion was marked at the center of each specimen. Specimens were individually placed in an ESD training model, and subjected to either 2D or 3D ESD. En bloc resection rate, perforation rate, incision time, dissection time, and levels of five eyestrain symptoms (fatigue, pain, blurred vision, head-heaviness, and headache; 100-mm visual analog scale) were compared between the 2D and 3D procedures. In a crossover design, 8 endoscopists each performed two 2D and two 3D procedures. RESULTS All 32 lesions were resected en block, but perforation occurred in one 2D procedure. Incision time was significantly shorter in 3D ESD than in 2D ESD (102.8 ± 42.1 s vs. 135.8 ± 65.7 s, p < 0.05). Dissection time was also significantly shorter in 3D ESD than in 2D ESD (366.3 ± 187.6 s vs. 517.8 ± 282.3 s, p < 0.05). Differences in levels of all symptoms except blurred vision between before and after ESD were larger in 3D ESD than in 2D ESD. CONCLUSIONS Incision time and dissection time were significantly shorter in 3D ESD compared with 2D ESD, but eyestrain was increased. Depth information from 3D images appears to facilitate rapid and stable ESD maneuvers.
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Operational effectiveness of three-dimensional flexible endoscopy: an ex vivo study using a new model. Surg Endosc 2019; 33:3612-3615. [PMID: 30617421 DOI: 10.1007/s00464-018-06645-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Two-dimensional (2D) images lack depth information and thus provide probabilistic recognition that do not completely match the actual three-dimensional (3D) information. Here, we investigated the operability of 3D endoscopes. METHODS A 3D operation model was developed by passing 20 silk threads through upper and lower plates at 2-mm intervals in front and back rows separated by 1 mm. We evaluated accuracy and time of operating an electrosurgical knife. A successful operation was defined as pulling only a front-row thread; an unsuccessful operation was defined as pulling no thread (miss) or simultaneously pulling front- and back-row threads. Endoscopists (four experts, six trainees) repeated the operation under 2D and 3D conditions until individually accumulating 10 successful attempts under each condition. RESULTS Operation accuracy was significantly higher for 3D compared with 2D in all endoscopists (88.5% vs. 61.3%; p < 0.01) and in both experience groups (trainees: 84.5% vs. 61.2%; experts: 95.2% vs. 61.5%; both p < 0.01). Operation time was significantly shorter for 3D compared with 2D in all endoscopists (12.5 ± 4.1 s vs. 14.8 ± 4.7 s; p < 0.01) and in both experience groups (trainees: 12.8 ± 4.2 s vs. 15.2 ± 4.9 s; experts: 12.1 ± 4.0 s vs. 14.3 ± 4.3 s; both p < 0.01). DISCUSSION Compared with 2D endoscopy, 3D endoscopy significantly improved operation accuracy and shortened operation time, suggesting that 3D endoscopy enables accurate operation by depth information, aiding spatial recognition.
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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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Smits AJ, Deunk J, Bloemers FW. Three-Dimensional Thoracoscopic Surgery for Spine Fractures: A Technical Report With First Results and Experiences. Global Spine J 2018; 8:821-826. [PMID: 30560034 PMCID: PMC6293422 DOI: 10.1177/2192568218775072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
STUDY DESIGN Technical report. OBJECTIVES Conventional 2-dimensional (2D) video-assisted thoracoscopy (VATS) is a technical procedure mainly performed by experienced surgeons. The technique may, however, come with difficulties in hand-eye coordination and estimation of depth. Three-dimensional thoracoscopy can help overcome these difficulties by providing a stereoscopic 3D view. The objective of this study is to report the first experience and results with 3D thoracoscopy for spine surgery in trauma patients. METHODS The first 4 patients treated with anterior stabilization for traumatic spine fractures using 3D thoracoscopy in an academic hospital are described. Baseline characteristics, operative time, and blood loss were retrospectively collected. This data is compared with a cohort of patients treated in the same center with the conventional 2D technique. Additionally, the treating surgeons' and residents' experience with the technique is described. Surgical equipment consists of 3D compatible video monitors, a videoscope with 2 cameras, and special glasses to be worn by the personnel. RESULTS Four patients were successfully treated using 3D thoracoscopy. Operative time was comparable to that of the conventional 2D technique and less blood loss occurred. No per- or postoperative complications or problems occurred. Per-operative views were of very high quality and provided improved depth perception. Surgeons and residents deemed the technique helpful, especially during technically demanding aspects of the procedure. CONCLUSIONS While a shorter learning curve, decreased surgery time, and blood loss have to be proven in future prospective studies, the first experience with 3D-VATS for spine surgery is positive, and future use in minimally invasive spine surgery seems feasible.
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Affiliation(s)
- Arjen J. Smits
- VU University Medical Centre, Amsterdam, Netherlands,Arjen J. Smits, Department of Traumasurgery, VU
University Medical Centre, De Boelelaan 1117, Room 7F020, 1081 HV Amsterdam, Netherlands.
| | - Jaap Deunk
- VU University Medical Centre, Amsterdam, Netherlands
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Kunert W, Auer T, Storz P, Braun M, Kirschniak A, Falch C. How Much Stereoscopic Effect Does Laparoscopy Need? Controlled, Prospective Randomized Trial on Surgical Task Efficiency in Standardized Phantom Tasks. Surg Innov 2018; 25:515-524. [DOI: 10.1177/1553350618784801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background. To regain 2-eyed vision in laparoscopy, dual-channeled optics have been introduced. With this optics design, the distance between the 2 front lenses defines how much stereoscopic effect is seen. This study quantifies the impact of an enhanced and a reduced stereo effect on surgical task efficiency. Methods. A prospective single-blinded study was performed with 20 laparoscopic novices in an inanimate experimental setting. A standard bichannelled stereo system was used to perform a suturing and knotting task. The working distance and the task size were scaled to vary the stereo effect and, thereby, simulate hypothetic stereo optics with enhanced and reduced optical bases. The task performances were timed, and the number of trials for stitching out was counted. The participants finally filled out a questionnaire to collect subjective impressions. Results. The increase of the stereo effect by 50% caused no objective improvement in laparoscopic knotting compared with typical 3D (control group with stereo basis of 4.5 mm). But ergonomic disadvantages (headache) were subjectively reported in 1 of 20 cases in the questionnaire. The reduction of the stereo effect by one-third led to a significantly longer average execution time. There was no significant dependence found between stereo effect and number of stich-out trials, stitching precision, or knotting quality. Conclusions. Considering laparoscopy, it does not seem advisable to enhance the stereo effect because of ergonomic problems. Otherwise, a miniaturization of the 3D scope (5 mm version) is problematic because its benefit mostly shrinks with the reduced stereo effect.
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Nomura K, Kaise M, Kikuchi D, Iizuka T, Fukuma Y, Kuribayashi Y, Tanaka M, Toba T, Furuhata T, Yamashita S, Matsui A, Mitani T, Hoteya S. Recognition accuracy of tumor extent using a prototype 3D endoscope for superficial gastric tumor: an ex vivo crossover study. Endosc Int Open 2018; 6:E652-E658. [PMID: 29868629 PMCID: PMC5979191 DOI: 10.1055/a-0577-3009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 01/03/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Many studies have shown the utility of rigid three-dimensional (3 D) endoscopes in surgery, but few have reported the utility of flexible 3 D endoscopes. This ex vivo study was intended to investigate whether a newly developed 3 D endoscope (GIF-Y0083; Olympus) improves diagnostic accuracy for superficial gastric tumor. METHODS Twelve observers comprising experts, trainees, and novices (4 each) evaluated 2 D and 3 D images of 20 specimens resected by gastric ESD. Evaluation items were diagnostic accuracy of tumor extent and degree of confidence in assessing (a) tumor extent, (b) morphology, and (c) comprehensive recognition. The 2 D and 3 D endoscopy data were compared in a crossover analysis. RESULTS Overall, diagnostic accuracy was significantly higher with 3 D images (88.1 %) than with 2 D images (84.2 %) ( P < 0.01). Comparison by skill level showed that 3 D images significantly improved diagnostic accuracy among novices but not among experts or trainees. Comparison by morphology showed that diagnostic accuracy did not differ significantly for type IIa/IIb lesions but improved significantly for type IIc lesions among trainees and novices. Overall, 3 D images significantly increased the degree of confidence in the assessment of all three items (a - c). Comparison by skill level showed similar results, and comparison by morphology showed that regardless of skill level, the degree of confidence in assessing all items (a - c) increased significantly only when examining type IIc lesions. CONCLUSION Compared with 2 D images, 3 D images significantly improved both diagnostic accuracy of tumor extent and degree of confidence for diagnosing superficial gastric tumor. The utility of the 3 D endoscope was apparent among trainees and novices and for the diagnosis of type IIc lesions.
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Affiliation(s)
- Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan,Corresponding author Kosuke Nomura, MD Department of GastroenterologyToranomon Hospital2-2-2 ToranomonMinato-ku, Tokyo 105-8470Japan+81-3-3582-7068
| | - Mitsuru Kaise
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yumiko Fukuma
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Takahito Toba
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Tsukasa Furuhata
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Toshifumi Mitani
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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Batmaz AU, de Mathelin M, Dresp-Langley B. Effects of 2D and 3D image views on hand movement trajectories in the surgeon’s peri-personal space in a computer controlled simulator environment. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1426232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Anil Ufuk Batmaz
- ICube Lab, CNRS and University of Strasbourg, UMR 7357, Strasbourg, France
| | - Michel de Mathelin
- ICube Lab, CNRS and University of Strasbourg, UMR 7357, Strasbourg, France
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21
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Zheng CH, Lu J, Zheng HL, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang CM. Comparison of 3D laparoscopic gastrectomy with a 2D procedure for gastric cancer: A phase 3 randomized controlled trial. Surgery 2017; 163:300-304. [PMID: 29195739 DOI: 10.1016/j.surg.2017.09.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relative safety and efficacy of 3D laparoscopic gastrectomy and 2D laparoscopic surgery in patients with gastric cancer. BACKGROUND There is still a lack of randomized controlled trials regarding the safety and efficacy of 3D versus 2D laparoscopic surgery for gastric cancer. METHODS A large-scale, phase 3, prospective, randomized controlled trial was conducted. (ClinicalTrials.gov number NCT02327481). RESULTS A total of 438 patients were randomized (3D group: 219 cases; 2D group: 219 cases) between January 1, 2015, and April 1, 2016; 19 patients were excluded. Finally, data from 419 patients were analyzed (3D group: 211 cases; 2D group: 208 cases). There were no differences between the 2 groups regarding the operation time (3D versus 2D, 176 ± 35 min vs. 174 ± 33 min, P = .562). The intraoperative blood loss in the 3D group was somewhat less than in the 2D group (61 ± 83 mL vs. 82 ± 119 mL, P = .045). Further analysis suggested that the use of 3D laparoscopic surgery was a protective factor against excessive blood loss (≥200 mL). CONCLUSION 3D laparoscopic gastrectomy did not shorten the operation time compared with 2D laparoscopic gastrectomy, but provided the benefit of less intraoperative blood loss and a lesser occurrence of excessive bleeding than the conventional 2D laparoscopic gastrectomy; the clinical value of the difference is limited.
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Affiliation(s)
- Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China.
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Batmaz AU, de Mathelin M, Dresp-Langley B. Seeing virtual while acting real: Visual display and strategy effects on the time and precision of eye-hand coordination. PLoS One 2017; 12:e0183789. [PMID: 28859092 PMCID: PMC5578485 DOI: 10.1371/journal.pone.0183789] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 08/11/2017] [Indexed: 11/18/2022] Open
Abstract
Effects of different visual displays on the time and precision of bare-handed or tool-mediated eye-hand coordination were investigated in a pick-and-place-task with complete novices. All of them scored well above average in spatial perspective taking ability and performed the task with their dominant hand. Two groups of novices, four men and four women in each group, had to place a small object in a precise order on the centre of five targets on a Real-world Action Field (RAF), as swiftly as possible and as precisely as possible, using a tool or not (control). Each individual session consisted of four visual display conditions. The order of conditions was counterbalanced between individuals and sessions. Subjects looked at what their hands were doing 1) directly in front of them (“natural” top-down view) 2) in top-down 2D fisheye view 3) in top-down undistorted 2D view or 4) in 3D stereoscopic top-down view (head-mounted OCULUS DK 2). It was made sure that object movements in all image conditions matched the real-world movements in time and space. One group was looking at the 2D images with the monitor positioned sideways (sub-optimal); the other group was looking at the monitor placed straight ahead of them (near-optimal). All image viewing conditions had significantly detrimental effects on time (seconds) and precision (pixels) of task execution when compared with “natural” direct viewing. More importantly, we find significant trade-offs between time and precision between and within groups, and significant interactions between viewing conditions and manipulation conditions. The results shed new light on controversial findings relative to visual display effects on eye-hand coordination, and lead to conclude that differences in camera systems and adaptive strategies of novices are likely to explain these.
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Affiliation(s)
- Anil U. Batmaz
- ICube Lab Robotics Department, University of Strasbourg, 1 Place de l'Hôpital, Strasbourg, France
| | - Michel de Mathelin
- ICube Lab Robotics Department, University of Strasbourg, 1 Place de l'Hôpital, Strasbourg, France
| | - Birgitta Dresp-Langley
- ICube Lab Cognitive Science Department, Centre National de la Recherche Scientifique, 1 Place de l'Hôpital, Strasbourg, France
- * E-mail:
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Baum S, Sillem M, Ney JT, Baum A, Friedrich M, Radosa J, Kramer KM, Gronwald B, Gottschling S, Solomayer EF, Rody A, Joukhadar R. What Are the Advantages of 3D Cameras in Gynaecological Laparoscopy? Geburtshilfe Frauenheilkd 2017; 77:45-51. [PMID: 28190888 DOI: 10.1055/s-0042-120845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction Minimally invasive operative techniques are being used increasingly in gynaecological surgery. The expansion of the laparoscopic operation spectrum is in part the result of improved imaging. This study investigates the practical advantages of using 3D cameras in routine surgical practice. Materials and Methods Two different 3-dimensional camera systems were compared with a 2-dimensional HD system; the operating surgeon's experiences were documented immediately postoperatively using a questionnaire. Results Significant advantages were reported for suturing and cutting of anatomical structures when using the 3D compared to 2D camera systems. There was only a slight advantage for coagulating. The use of 3D cameras significantly improved the general operative visibility and in particular the representation of spacial depth compared to 2-dimensional images. There was not a significant advantage for image width. Depiction of adhesions and retroperitoneal neural structures was significantly improved by the stereoscopic cameras, though this did not apply to blood vessels, ureter, uterus or ovaries. Conclusion 3-dimensional cameras were particularly advantageous for the depiction of fine anatomical structures due to improved spacial depth representation compared to 2D systems. 3D cameras provide the operating surgeon with a monitor image that more closely resembles actual anatomy, thus simplifying laparoscopic procedures.
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Affiliation(s)
- S Baum
- Klinik für Frauenheilkunde und Geburtshilfe, UKSH Klinik für Frauenheilkunde und Geburtshilfe Campus Lübeck, Lübeck, Germany; Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde und Geburtshilfe, Homburg/Saar, Germany
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim, Germany
| | - J T Ney
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Baum
- Praxis Prof. Dr. Dhom & Partner, Ludwigshafen, Germany
| | - M Friedrich
- Frauenklinik, HELIOS-Klinikum Krefeld, Krefeld, Germany
| | - J Radosa
- Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde und Geburtshilfe, Homburg/Saar, Germany
| | - K M Kramer
- Viszera Chirurgie-Zentrum, Munich, Germany
| | - B Gronwald
- Zentrum für Palliativmedizin und Kinderschmerztherapie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - S Gottschling
- Universitätsklinikum des Saarlandes, Zentrum für Palliativmedizin und Kinderschmerztherapie, Homburg/Saar
| | - E F Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Rody
- Klinik für Frauenheilkunde und Geburtshilfe, UKSH Klinik für Frauenheilkunde und Geburtshilfe Campus Lübeck, Lübeck, Germany
| | - R Joukhadar
- Universitätsfrauenklinik Würzburg, Würzburg, Germany
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Abou-Haidar H, Al-Qaoud T, Jednak R, Brzezinski A, El-Sherbiny M, Capolicchio JP. Laparoscopic pyeloplasty: Initial experience with 3D vision laparoscopy and articulating shears. J Pediatr Urol 2016; 12:426.e1-426.e5. [PMID: 27889223 DOI: 10.1016/j.jpurol.2016.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/30/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Laparoscopic reconstructive surgery is associated with a steep learning curve related to the use of two-dimensional (2D) vision and rigid instruments. With the advent of robotic surgery, three-dimensional (3D) vision, and articulated instruments, this learning curve has been facilitated. We present a hybrid alternative to robotic surgery, using laparoscopy with 3D vision and articulated shears. OBJECTIVE To compare outcomes of children undergoing pyeloplasty using 3D laparoscopy with articulated instruments with those undergoing the same surgery using standard laparoscopy with 2D vision and rigid instruments. STUDY DESIGN Medical charts of 33 consecutive patients with ureteropelvic junction obstruction who underwent laparoscopic pyeloplasty by a single surgeon from 2006 to 2013 were reviewed in a retrospective manner. The current 3D cohort was compared with the previous 2D cohort. Data on age, weight, gender, side, operative time, dimension (2D = 19 patients, 3D = 8 patients), presence of a crossing vessel, length of hospital stay, and complication rate were compared between the two groups. Articulating shears were used for pelvotomy and spatulation of the ureter in the 3D group. Statistical tests included linear regression models and chi square tests for trends using STATA software. RESULTS Operative time per case was decreased by an average of 48 min in the group undergoing 3D laparoscopic pyeloplasty compared with the group undergoing 2D laparoscopic pyeloplasty (p = 0.02) (Figure). Complication rate and length of hospital stay were not significantly affected by the use of 3D laparoscopy. DISCUSSION These favorable results are in accordance with previous literature emphasizing the importance of 3D vision in faster and more precise execution of complex surgical maneuvers. The use of flexible instruments has also helped overcome the well-described delicate step of a dismembered pyeloplasty, namely the pelvotomy and ureteral spatulation. Limitations of this study are those inherent to the retrospective study design. CONCLUSION The use of 3D vision endoscopy with articulating instruments blurs the distinction between current robotic-assisted and conventional laparoscopic technology, and provides a hybrid alternative deserving further attention.
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Affiliation(s)
- Hiba Abou-Haidar
- Montreal Children's Hospital, McGill University Health Centre, Department of Pediatric Surgery, Division of Pediatric Urology, Montreal, Quebec, Canada
| | - Talal Al-Qaoud
- Montreal Children's Hospital, McGill University Health Centre, Department of Pediatric Surgery, Division of Pediatric Urology, Montreal, Quebec, Canada
| | - Roman Jednak
- Montreal Children's Hospital, McGill University Health Centre, Department of Pediatric Surgery, Division of Pediatric Urology, Montreal, Quebec, Canada
| | - Alex Brzezinski
- Montreal Children's Hospital, McGill University Health Centre, Department of Pediatric Surgery, Division of Pediatric Urology, Montreal, Quebec, Canada
| | - Mohamed El-Sherbiny
- Montreal Children's Hospital, McGill University Health Centre, Department of Pediatric Surgery, Division of Pediatric Urology, Montreal, Quebec, Canada
| | - John-Paul Capolicchio
- Montreal Children's Hospital, McGill University Health Centre, Department of Pediatric Surgery, Division of Pediatric Urology, Montreal, Quebec, Canada.
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Lu J, Zheng CH, Zheng HL, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang CM. Randomized, controlled trial comparing clinical outcomes of 3D and 2D laparoscopic surgery for gastric cancer: an interim report. Surg Endosc 2016; 31:2939-2945. [PMID: 27826781 DOI: 10.1007/s00464-016-5310-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/25/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In this study, we evaluated the short-term outcomes following three-dimensional (3D) or two-dimensional (2D) laparoscopic surgery for patients with gastric cancer. BACKGROUND There is a lack of prospective evidence regarding the safety and efficacy of 3D versus 2D laparoscopic surgery for patients with gastric cancer. Therefore, we conducted a phase III single-center, prospective, randomized, controlled trial to compare 3D and 2D laparoscopic surgery for patients with gastric cancer. METHODS We compared operation time, intraoperative blood loss, number of lymph node dissections, morbidity, and mortality between the 3D and 2D groups following laparoscopic surgery for gastric cancer. The study is registered at ClinicalTrials.gov with ID number NCT02327481. RESULTS A total of 228 patients were randomized (3D group 115 cases; 2D group 113 cases) between January 1, 2015 and September 1, 2015. Seven patients who underwent exploratory operations were excluded. Finally, a total of 221 patients were analyzed (3D group 109 cases, 2D group 112 cases). There were no significant differences between the two groups regarding the clinical pathological characteristics, operating time (3D vs. 2D, 184 ± 36 vs. 178 ± 37 min, P = 0.288), number of lymph node dissections (36 ± 14 vs. 37 ± 13, P = 0.698), time to first ambulation (2.27 ± 1.60 vs. 2.04 ± 0.84, P = 0.18), flatus (3.89 ± 1.49 vs. 3.69 ± 1.12, P = 0.255), liquid diet (4.88 ± 1.88 vs. 4.79 ± 1.57, P = 0.684), or duration of postoperative hospital stay (12.52 ± 4.83 vs. 12.63 ± 7.32, P = 0.903). The postoperative complication rates of the 3D and 2D groups were 18.3 and 16.1%, respectively, P = 0.723. No patients died during the postoperative hospital stay. However, the intraoperative blood loss in the 3D group was significantly lower than the 2D group (58 ± 75 vs. 78 ± 72 ml, P = 0.047). CONCLUSION There was no significant difference in operation time and number of lymph node harvested between the 3D and 2D groups; however, 3D laparoscopic surgery may reduce the intraoperative blood loss compared to 2D procedure. Therefore, we conclude that this trial is safe and is thus ongoing.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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Fanfani F, Rossitto C, Restaino S, Ercoli A, Chiantera V, Monterossi G, Barbati G, Scambia G. How Technology Can Impact Surgeon Performance: A Randomized Trial Comparing 3-Dimensional versus 2-Dimensional Laparoscopy in Gynecology Oncology. J Minim Invasive Gynecol 2016; 23:810-7. [PMID: 27046747 DOI: 10.1016/j.jmig.2016.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 11/19/2022]
Abstract
This randomized clinical trial (Canadian Task Force classification I) aimed to compare 2-dimension (2-D) versus 3-dimensional (3-D) laparoscopic hysterectomy and pelvic lymphadenectomy in endometrial and cervical cancer patients. Between December 2014 and March 2015, 90 patients were enrolled: 29 (32.2%) with early or locally advanced cervical cancer after neoadjuvant treatment and 61 (67.8%) with early-stage endometrial cancer. Patients were randomly assigned to undergo 2-D (Group A, n = 48 [53.3%]) or 3-D (Group B, n = 42 [46.7%)]) laparoscopy. Baseline characteristics were superimposable in the 2 groups. Median operative time was similar in the 2 groups. Median estimated blood loss during lymphadenectomy was significantly lower in Group B than in Group A (38 mL [range, 0-450] vs 65 mL [range, 0-200]; p = .033). In cervical cancer patients operative time of pelvic lymphadenectomy performed by "novice" surgeons (those with <10 procedures performed) was statistically significantly lower in Group B (p = .047). No differences in perioperative outcomes and postoperative complications were observed between the 2 groups. The 2-D and 3-D systems can be used safely in laparoscopic hysterectomy. However, the 3-D system could provide key benefits to intraoperative techniques and postoperative outcomes in reducing operative time for "expert" surgeons and in enhancing surgical precision for "novice" surgeons.
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Affiliation(s)
- Francesco Fanfani
- Department of Medicine and Aging Sciences, University "G.D'Annunzio", Chieti-Pescara, Italy.
| | - Cristiano Rossitto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Stefano Restaino
- Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University Hospital Maggiore della Carità, Novara, Italy
| | - Vito Chiantera
- Department of Obstetrics and Gynecology, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Giorgia Monterossi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Giulia Barbati
- Medicine Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
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Short-Term Outcome of Three-Dimensional Versus Two-Dimensional Video-Assisted Thoracic Surgery for Benign Pulmonary Diseases. Ann Thorac Surg 2016; 101:1297-302. [DOI: 10.1016/j.athoracsur.2015.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/25/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023]
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Abstract
Minimally invasive surgery (MIS) poses visual challenges to the surgeons. In MIS, binocular disparity is not freely available for surgeons, who are required to mentally rebuild the 3-dimensional (3D) patient anatomy from a limited number of monoscopic visual cues. The insufficient depth cues from the MIS environment could cause surgeons to misjudge spatial depth, which could lead to performance errors thus jeopardizing patient safety. In this article, we will first discuss the natural human depth perception by exploring the main depth cues available for surgeons in open procedures. Subsequently, we will reveal what depth cues are lost in MIS and how surgeons compensate for the incomplete depth presentation. Next, we will further expand our knowledge by exploring some of the available solutions for improving depth presentation to surgeons. Here we will review the innovative approaches (multiple 2D camera assembly, shadow introduction) and devices (3D monitors, head-mounted devices, and auto-stereoscopic monitors) for 3D image presentation from the past few years.
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Affiliation(s)
| | | | - Bin Zheng
- University of Alberta, Edmonton, Alberta, Canada
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Yang C, Mo L, Ma Y, Peng G, Ren Y, Wang W, Liu Y, He J. A comparative analysis of lung cancer patients treated with lobectomy via three-dimensional video-assisted thoracoscopic surgery versus two-dimensional resection. J Thorac Dis 2015; 7:1798-805. [PMID: 26623103 DOI: 10.3978/j.issn.2072-1439.2015.10.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Three-dimensional (3D) vision systems are now available for thoracic surgery. It is unclear whether 3D video-assisted thoracic surgery (VATS) is superior to 2D VATS systems. This study aimed to compare the operative and perioperative data between 2D and 3D VATS lobectomy (VTL) and to identify the actual role of 3D VTL in thoracic surgery. METHODS A two-institutional comparative study was conducted from November 2013 to November 2014 at Liaoning Cancer Hospital & Institute and the First Affiliated Hospital of Guangzhou Medical University, China, of 300 patients with resectable non-small cell lung cancer (NSCLC). Patients were assigned to receive either the 3D VATS (n=150) or 2D VATS (n=150) lobectomy. The operative and perioperative data between 2D VATS and 3D VATS were compared. RESULTS Although there was no significant difference between the two groups regarding the incidence of each single complication, a significantly less operative time was found in the 3D VATS group (145 min) than in the 2D VATS group (176 min) (P=0.006). Postoperative mortality rates in 3D VATS and 2D VATS groups were both 0%.No significant difference was found between groups for estimated blood loss (P=0.893), chest drainage tube placement time (P=0.397), length of hospital stay (P=0.199), number of lymph nodes resected (P=0.397), postoperative complications (P=0.882) and cost of care (P=0.913). CONCLUSIONS Early results of this study demonstrate that the 3D VATS lobectomy procedure can be performed with less operative time. 3D VATS and 2D VATS lobectomy are both safe procedures in first-line surgical treatment of NSCLC.
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Affiliation(s)
- Chengliang Yang
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lili Mo
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yegang Ma
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Guilin Peng
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yi Ren
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yongyu Liu
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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Sørensen SMD, Savran MM, Konge L, Bjerrum F. Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review. Surg Endosc 2015; 30:11-23. [PMID: 25840896 DOI: 10.1007/s00464-015-4189-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/23/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. METHODS A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. RESULTS Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71%) showed a reduction in performance time, and 12 out of 19 (63%) showed a significant reduction in error when using 3D compared to 2D. CONCLUSIONS Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.
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Affiliation(s)
- Stine Maya Dreier Sørensen
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark.
| | - Mona Meral Savran
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark
| | - Flemming Bjerrum
- Department of Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Two-Dimensional Versus Three-Dimensional Laparoscopy: Evaluation of Physicians' Performance and Preference Using a Pelvic Trainer. J Minim Invasive Gynecol 2015; 22:421-7. [DOI: 10.1016/j.jmig.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/09/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
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Bove P, Iacovelli V, Celestino F, De Carlo F, Vespasiani G, Finazzi Agrò E. 3D vs 2D laparoscopic radical prostatectomy in organ-confined prostate cancer: comparison of operative data and pentafecta rates: a single cohort study. BMC Urol 2015; 15:12. [PMID: 25887253 PMCID: PMC4349673 DOI: 10.1186/s12894-015-0006-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/09/2015] [Indexed: 11/13/2022] Open
Abstract
Background Currently, men are younger at the time of diagnosis of prostate cancer and more interested in less invasive surgical approaches (traditional laparoscopy, 3D-laparoscopy, robotics). Outcomes of continence, erectile function, cancer cure, positive surgical margins and complication are well collected in the pentafecta rate. However, no comparative studies between 4th generation 3D-HD vision system laparoscopy and standard bi-dimensional laparoscopy have been reported. This study aimed to compare the operative, perioperative data and pentafecta rates between 2D and 3D laparoscopic radical prostatectomy (LRP) and to identify the actual role of 3D LRP in urology. Methods From October 2012 to July 2013, 86 patients with clinically localized prostate cancer [PCa: age ≤ 70 years, prostate-specific antigen (PSA) ≤ 10 ng/ml, biopsy Gleason score ≤ 7] underwent laparoscopic extraperitoneal radical prostatectomy (LERP) and were followed for approximately 14 months (range 12–25). Patients were selected for inclusion via hospital record data, and divided into two groups. Their patient records were then analyzed. Patients were randomized into two groups: the former 2D-LERP (43 pts) operated with the use of 2D-HD camera; the latter 3D-LERP (43 pts) operated with the use of a 3D-HD 4th generation view system. The operative and perioperative data and the pentafecta rates between 2D-LERP and 3D-LERP were compared. Results The overall pentafecta rates at 3 months were 47.4% and 49.6% in the 2D- and 3D-LERP group respectively. The pentafecta rate at 12 months was 62.7% and 67% for each group respectively. 4th generation 3D-HD vision system provides advantages over standard bi-dimensional view with regard to intraoperative steps. Our data suggest a trend of improvement in intraoperative blood loss and postoperative recovery of continence with the respect of the oncological safety. Conclusions Use of the 3D technology by a single surgeon significantly enhances the possibility of achieving better intraoperative results and pentafecta in all patients undergoing LERP. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. Nevertheless, further studies are necessary to better comprehend the role of 3D-LERP in modern urology.
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Affiliation(s)
- Pierluigi Bove
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Valerio Iacovelli
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Francesco Celestino
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Francesco De Carlo
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Giuseppe Vespasiani
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Enrico Finazzi Agrò
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
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An assessment of the new generation three-dimensional high definition laparoscopic vision system on surgical skills: a randomized prospective study. Surg Endosc 2014; 29:2305-13. [DOI: 10.1007/s00464-014-3949-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/14/2014] [Indexed: 11/26/2022]
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Kinoshita H, Nakagawa K, Usui Y, Iwamura M, Ito A, Miyajima A, Hoshi A, Arai Y, Baba S, Matsuda T. High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems. Surg Endosc 2014; 29:2203-9. [PMID: 25361650 DOI: 10.1007/s00464-014-3925-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/30/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Three-dimensional (3D) imaging systems have been introduced worldwide for surgical instrumentation. A difficulty of laparoscopic surgery involves converting two-dimensional (2D) images into 3D images and depth perception rearrangement. 3D imaging may remove the need for depth perception rearrangement and therefore have clinical benefits. METHODS We conducted a multicenter, open-label, randomized trial to compare the surgical outcome of 3D-high-definition (HD) resolution and 2D-HD imaging in laparoscopic radical prostatectomy (LRP), in order to determine whether an LRP under HD resolution 3D imaging is superior to that under HD resolution 2D imaging in perioperative outcome, feasibility, and fatigue. One-hundred twenty-two patients were randomly assigned to a 2D or 3D group. The primary outcome was time to perform vesicourethral anastomosis (VUA), which is technically demanding and may include a number of technical difficulties considered in laparoscopic surgeries. RESULTS VUA time was not significantly shorter in the 3D group (26.7 min, mean) compared with the 2D group (30.1 min, mean) (p = 0.11, Student's t test). However, experienced surgeons and 3D-HD imaging were independent predictors for shorter VUA times (p = 0.000, p = 0.014, multivariate logistic regression analysis). Total pneumoperitoneum time was not different. No conversion case from 3D to 2D or LRP to open RP was observed. Fatigue was evaluated by a simulation sickness questionnaire and critical flicker frequency. Results were not different between the two groups. Subjective feasibility and satisfaction scores were significantly higher in the 3D group. CONCLUSIONS Using a 3D imaging system in LRP may have only limited advantages in decreasing operation times over 2D imaging systems. However, the 3D system increased surgical feasibility and decreased surgeons' effort levels without inducing significant fatigue.
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Affiliation(s)
- Hidefumi Kinoshita
- Department Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan,
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Mashiach R, Mezhybovsky V, Nevler A, Gutman M, Ziv A, Khaikin M. Three-dimensional imaging improves surgical skill performance in a laparoscopic test model for both experienced and novice laparoscopic surgeons. Surg Endosc 2014; 28:3489-93. [DOI: 10.1007/s00464-014-3635-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/16/2014] [Indexed: 12/22/2022]
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Usta TA, Karacan T, Naki MM, Calık A, Turkgeldi L, Kasimogullari V. Comparison of 3-dimensional versus 2-dimensional laparoscopic vision system in total laparoscopic hysterectomy: a retrospective study. Arch Gynecol Obstet 2014; 290:705-9. [PMID: 24791965 DOI: 10.1007/s00404-014-3253-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/11/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We compare the results of total laparoscopic hysterectomy (TLH) operations conducted using standard 2-D and 3-D high definition laparoscopic vision systems and discuss the findings with regard to the recent literature. METHODS Data from 147 patients who underwent TLH operations with 2-D or 3-D high definition laparoscopic vision systems in Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, during 2 year period between December 2010 and December 2012, were reviewed retrospectively. TLH operations were divided into two groups as those performed using 2-D, and those performed using 3-D high definition laparoscopic vision systems. RESULTS A statistically significant difference was found between the two groups in the operation times (p = 0.037 < 0.05). The mean operation time of the 2-D laparoscopy group (134.2 ± 61.8 min) was higher than the 3-D laparoscopy group (116.8 ± 38.5 min). No statistically significant difference was found between the 2-D and 3-D groups with respect to major, minor and total complication rates (p = 0.641 > 0.05). The operation time among obese patients was significantly shorter in those in the 3-D laparoscopy group than those in the 2-D group (p = 0.041 < 0.05). CONCLUSIONS Recent literature indicates that 3-D laparoscopy vision system needs to be utilized more often and a higher number of ex vivo and in vivo studies have to be conducted. Furthermore, we believe that the prevalent problems encountered during laparoscopy can be overcome by the development of real-time vision devices and the appropriate training of the laparoscopists. 3-D high definition laparoscopic vision system will help to improve surgical performance and outcome of patients undergoing gynecological minimal invasive surgery.
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Affiliation(s)
- Taner A Usta
- Department of Obstetrics and Gynecology, Bagcilar Education and Research Hospital, Bagcilar, 34200, Istanbul, Turkey,
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Tanagho YS, Andriole GL, Paradis AG, Madison KM, Sandhu GS, Varela JE, Benway BM. 2D Versus 3D Visualization: Impact on Laparoscopic Proficiency Using the Fundamentals of Laparoscopic Surgery Skill Set. J Laparoendosc Adv Surg Tech A 2012; 22:865-70. [DOI: 10.1089/lap.2012.0220] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Youssef S. Tanagho
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gerald L. Andriole
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Alethea G. Paradis
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kerry M. Madison
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gurdarshan S. Sandhu
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - J. Esteban Varela
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Brian M. Benway
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Song GA. The evolution of the conventional endoscope in an era of 3-dimensional technology. Clin Endosc 2012; 45:181. [PMID: 22977797 PMCID: PMC3429731 DOI: 10.5946/ce.2012.45.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/19/2012] [Accepted: 07/19/2012] [Indexed: 11/14/2022] Open
Affiliation(s)
- Geun Am Song
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Wagner OJ, Hagen M, Kurmann A, Horgan S, Candinas D, Vorburger SA. Three-dimensional vision enhances task performance independently of the surgical method. Surg Endosc 2012; 26:2961-8. [PMID: 22580874 DOI: 10.1007/s00464-012-2295-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 04/02/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical skills and task performance. METHODS In this study, 34 individuals with varying laparoscopic experience (18 inexperienced individuals) performed three tasks to test spatial relationships, grasping and positioning, dexterity, precision, and hand-eye and hand-hand coordination. Each task was performed in 3D using binocular vision for open performance, the Viking 3Di Vision System for laparoscopic performance, and the DaVinci robotic system. The same tasks were repeated in 2D using an eye patch for monocular vision, conventional laparoscopy, and the DaVinci robotic system. RESULTS Loss of 3D vision significantly increased the perceived difficulty of a task and the time required to perform it, independently of the approach (P < 0.0001-0.02). Simple tasks took 25 % to 30 % longer to complete and more complex tasks took 75 % longer with 2D than with 3D vision. Only the difficult task was performed faster with the robot than with laparoscopy (P = 0.005). In every case, 3D robotic performance was superior to conventional laparoscopy (2D) (P < 0.001-0.015). CONCLUSIONS The more complex the task, the more 3D vision accelerates task completion compared with 2D vision. The gain in task performance is independent of the surgical method.
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Affiliation(s)
- O J Wagner
- Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
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Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera. Surg Endosc 2009; 24:1132-43. [PMID: 19911222 DOI: 10.1007/s00464-009-0740-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 10/12/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study evaluated the effects of a three-dimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system. METHODS In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles. RESULTS The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system. CONCLUSION The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery.
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Barry GP, Simon JW, Auringer D, Dunnican W, Zobal-Ratner J. Performance of strabismic subjects using a validated surgical training module: a pilot study. J AAPOS 2009; 13:350-3, 353.e1-2. [PMID: 19683186 DOI: 10.1016/j.jaapos.2009.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 04/28/2009] [Accepted: 05/02/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the performance of patients with strabismus to that of age-matched controls in a validated surgical training module. METHODS A prospective experimental study was conducted of 14 adult patients with strabismus since childhood and absent stereopsis and of 14 age-matched controls with normal stereopsis. Each participant received instruction in the task of peg transfer on a validated surgical training device and then completed 10 consecutive timed trials. The means of the best 5 scores were compared using the 2-sample Wilcoxon rank-sum test. RESULTS The average age of cases was 34.8 years (range, 15-51 years) compared with 37.8 years (range, 14-56 years) for controls. The scores for the strabismic patients ranged from 50.8 to 151.4 seconds, with a mean of 82.5 +/- 26.7 seconds. Controls ranged from 43.2 to 129 seconds, with a mean of 64.7 +/- 23.9 seconds. The Wilcoxon rank-sum test showed significantly better performance among controls (p = 0.022). CONCLUSIONS Patients with strabismus performed more poorly than did age-matched controls in this model of hand-eye coordination. However, there was significant overlap between groups and several patients with strabismus performed better than the mean of the control group. Further investigation is required to elucidate the impact of strabismus on surgical performance.
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Affiliation(s)
- Gerard P Barry
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
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Vasilyev NV, Novotny PM, Martinez JF, Loyola H, Salgo IS, Howe RD, del Nido PJ. Stereoscopic vision display technology in real-time three-dimensional echocardiography-guided intracardiac beating-heart surgery. J Thorac Cardiovasc Surg 2008; 135:1334-41. [DOI: 10.1016/j.jtcvs.2007.12.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 11/16/2007] [Accepted: 12/06/2007] [Indexed: 11/25/2022]
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Patel HRH, Ribal MJ, Arya M, Nauth-Misir R, Joseph JV. Is it worth revisiting laparoscopic three-dimensional visualization? A validated assessment. Urology 2007; 70:47-9. [PMID: 17656206 DOI: 10.1016/j.urology.2007.03.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 02/02/2007] [Accepted: 03/02/2007] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Pure laparoscopic urologic surgery is becoming the standard of care for many urologic procedures. Training surgeons without any experience in the field is still a challenge. It is well recognized that two-dimensional optics causes difficulty for the novice. Thus, we assessed a new-generation, three-dimensional (3D) visualization system. METHODS Fifteen laparoscopically novice surgeons were asked to perform five validated laparoscopic training exercises using the two-dimensional and 3D systems in random order: (a) linear cutting and suturing; (b) curved cutting and suturing; (c) tubular suturing; (d) dorsal vein complex suturing simulation; and (e) urethrovesical anastomosis. The objective (time taken to complete the task versus the time needed by an expert) and subjective (accuracy on completion versus an expert's) scoring were performed independently by advanced laparoscopists. Statistical analysis was performed using the t test. RESULTS All tasks were completed by the participants. The statistical analysis revealed a trend toward improved task performance using 3D visualization. CONCLUSIONS Our preliminary testing has suggested that the new-generation, 3D system used will be helpful for developing skills in laparoscopy for the novice surgeon.
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Affiliation(s)
- Hitendra R H Patel
- Section of Laparoscopic Urology, Institute of Urology, University College London Hospitals, London, United Kingdom.
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Hassan I, Gerdes B, Koller M, Dick B, Hellwig D, Rothmund M, Zielke A. Spatial perception predicts laparoscopic skills on virtual reality laparoscopy simulator. Childs Nerv Syst 2007; 23:685-9. [PMID: 17429656 DOI: 10.1007/s00381-007-0330-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Indexed: 11/25/2022]
Abstract
OBJECTS This study evaluates the influence of visual-spatial perception on laparoscopic performance of novices with a virtual reality simulator (LapSim(R)). MATERIALS AND METHODS Twenty-four novices completed standardized tests of visual-spatial perception (Lameris Toegepaste Natuurwetenschappelijk Onderzoek [TNO] Test(R) and Stumpf-Fay Cube Perspectives Test(R)) and laparoscopic skills were assessed objectively, while performing 1-h practice sessions on the LapSim(R), comprising of coordination, cutting, and clip application tasks. Outcome variables included time to complete the tasks, economy of motion as well as total error scores, respectively. RESULTS The degree of visual-spatial perception correlated significantly with laparoscopic performance on the LapSim(R) scores. Participants with a high degree of spatial perception (Group A) performed the tasks faster than those (Group B) who had a low degree of spatial perception (p = 0.001). Individuals with a high degree of spatial perception also scored better for economy of motion (p = 0.021), tissue damage (p = 0.009), and total error (p = 0.007). CONCLUSION Among novices, visual-spatial perception is associated with manual skills performed on a virtual reality simulator. This result may be important for educators to develop adequate training programs that can be individually adapted.
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Affiliation(s)
- I Hassan
- Department of Visceral-, Thoracic-, and Vascular Surgery, Philipps University of Marburg, Baldinger Strasse, 35043, Marburg, Germany.
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Heemskerk J, Zandbergen R, Maessen JG, Greve JWM, Bouvy ND. Advantages of advanced laparoscopic systems. Surg Endosc 2006; 20:730-3. [PMID: 16528462 DOI: 10.1007/s00464-005-0456-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 11/06/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conventional laparoscopy offers great benefits to our patients, but suffers from major technical drawbacks. Advanced laparoscopic systems are being developed addressing some of these drawbacks. METHODS We performed a training-box based study, performing laparoscopic tasks using conventional laparoscopy and advanced laparoscopic systems in order to assess the influence of these technical drawbacks in order to predict where the biggest advantages of newly developed surgical systems can be expected. RESULTS The most significant technical drawbacks were two-dimensional vision, disturbed eye-hand target axis and (possibly to a lesser extent) the rigid instruments with a limited five degrees of freedom. CONCLUSION Major advances in advanced laparoscopy might only be expected using console-based robot-arm manipulated systems like the daVinci surgical system, or a combination of a high-quality 3-dimensional vision system, restoration of the eye-hand-target axis and the use of an advanced handheld instrument offering seven degrees of freedom such as the Radius surgical system.
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Affiliation(s)
- J Heemskerk
- Department of Surgery, Maastricht University Hospital, P. DeByelaan 25, PO Box 5800, Maastricht, AZ 6202, The Netherlands.
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Raskar R, Tan KH, Feris RS, Turk M, Kobler J, Yu J. Harnessing real-world depth edges with multiflash imaging. IEEE COMPUTER GRAPHICS AND APPLICATIONS 2005; 25:32-38. [PMID: 15691169 DOI: 10.1109/mcg.2005.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Berci G. Commentary. Regarding the article "three dimensional view in endoscopic surgery" by N. Ishikawa et al. Surg Endosc 2004; 18:1288. [PMID: 15457388 DOI: 10.1007/s00464-004-8118-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Berci
- Cedars-Sinai Medical Center, 8700 Beverly, Boulevard, 90048, Los Angeles, CA, USA.
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Jourdan IC, Dutson E, Garcia A, Vleugels T, Leroy J, Mutter D, Marescaux J. Stereoscopic vision provides a significant advantage for precision robotic laparoscopy. Br J Surg 2004; 91:879-85. [PMID: 15227695 DOI: 10.1002/bjs.4549] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Current surgical robots provide no sense of touch and rely solely upon vision. This study evaluated the effect of new stereoscopic technology on the performance of robotic precision laparoscopy. METHODS Eight experienced laparoscopists with no experience in robotics performed five tasks of increasing complexity using a laparoscopic robot. The tasks were as follows: rope pass, paper cut, needle capping, knot tying and needle threading. Each test was performed ten times under both stereoscopic and monoscopic conditions. Performance times and errors were recorded. RESULTS Mean(s.e.m.) final performance times were calculated from the final five trial times for each test, and were as follows for monoscopic and stereoscopic conditions respectively: rope pass 112.8(4.2) and 97.0(3.7) s (P = 0.013), paper cut 117.1(6.0) and 98.4(9.8) s (P = 0.020), needle capping 144.5(12.7) and 99.7(6.8) s (P = 0.008), knot tying 138.7(14.3) and 70.3(6.0) s (P = 0.002), and needle threading 210.8(28.2) and 92.3(4.1) s (P = 0.002). The mean(s.e.m.) number of errors per candidate was 60.6(7.8) and 20.8(3.9) under monoscopic and stereoscopic conditions respectively (P = 0.004). CONCLUSION Stereoscopic vision provided a significant advantage during robotic laparoscopy in situations that required a precise understanding of structural orientation.
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Affiliation(s)
- I C Jourdan
- European Institute of Telesurgery, Hôpitaux Universitaires, Strasbourg 67 000, France
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Mueller-Richter UDA, Limberger A, Weber P, Ruprecht KW, Spitzer W, Schilling M. Possibilities and limitations of current stereo-endoscopy. Surg Endosc 2004; 18:942-7. [PMID: 15108113 DOI: 10.1007/s00464-003-9097-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2003] [Accepted: 10/02/2003] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stereo-endoscopy has become a commonly used technology. In many comparative studies striking advantages of stereo-endoscopy over two-dimensional presentation could not be proven. To show the potential and fields for further improvement of this technology is the aim of this article. METHOD The physiological basis of three-dimensional vision limitations of current stereo-endoscopes is discussed and fields for further research are indicated. New developments in spatial picture acquisition and spatial picture presentation are discussed. RESULTS Current limitations of stereo-endoscopy that prevent a better ranking in comparative studies with two-dimensional presentation are mainly based on insufficient picture acquisition. CONCLUSION Devices for three-dimensional picture presentation are at a more advanced developmental stage than devices for three-dimensional picture acquisition. Further research should emphasize the development of new devices for three-dimensional picture acquisition.
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Affiliation(s)
- U D A Mueller-Richter
- Department of Oral and Maxillofacial Surgery, Gebäude 71, University of Saarland, 66421, Homburg/Saar, Germany.
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