Skills Comparison in Pediatric Residents Using a 2-Dimensional versus a 3-Dimensional High-Definition Camera in a Pediatric Laparoscopic Simulator

INCREASING THE VISIBILITY DURING INTERNAL LIMITING MEMBRANE PEELING IN VITRECTOMY SURGERY: Evaluation of Monochrome Mode with Brilliant Blue G Staining Using the NGENUITY 3D Visualization System

PURPOSE

The aim of the study is to explore the effectiveness of using monochrome mode with Brilliant Blue G during vitrectomy surgery with the NGENUITY 3D Visualization System.

METHODS

Vitrectomy cases involving BBG-stained internal limiting membrane peeling with the NGENUITY 3D Visualization System (Alcon Laboratories, Inc.) at Juntendo University Urayasu Hospital from October 2022 to February 2023 were selected. The contrast ratios between peeled and stained internal limiting membrane areas under three settings were assessed: normal, yellow, and monochrome. In the monochrome setting, a yellow hue was used with zero saturation, while the Friedman test compared these ratios.

RESULTS

Nineteen patients (19 eyes; 7 males, 12 females; average age 68.5 ± 10.3 years) with retinal conditions such as epiretinal membrane (n = 11), macular hole (n = 4), macular traction syndrome (n = 3), and retinoschisis (n = 1) were included. We obtained contrast ratios of 1.57 ± 0.21 (normal), 1.60 ± 0.21 (yellow), and 1.92 ± 0.29 (monochrome). The monochrome setting showed significantly higher contrast than that shown by the normal and yellow settings (P = 0.0001, P = 0.0005), with no difference between the normal and yellow settings (P = 0.903).

CONCLUSION

Monochrome mode in NGENUITY with Brilliant Blue G potentially enhances contrast and increases visibility during internal limiting membrane peeling.

Upcoming multi-visceral robotic surgery systems: a SAGES review

BACKGROUND

Robotic surgical procedures continue to increase both in the United States (US) and worldwide. Several novel robotic surgical platforms are under development or undergoing regulatory approval. This review explores robotic platforms that are expected to reach US consumers within the next 2-3 years.

METHODS

The SAGES Robotic Platforms Working Group identified robotic surgery platforms in various stages of development and selected multi-visceral systems nearing or completing the US Food and Drug Administration (FDA) approval process. We outline key system components including architecture, unique features, development status, regulatory approval, and expected markets.

RESULTS

We identified twenty robotic platforms that met our selection criteria. Ten companies were based in North America, and ten were based in Europe or Asia. Each system is described in detail and key features are summarized in table form for easy comparison.

CONCLUSION

The emergence of novel robotic surgical platforms represents an important evolution in the growth of minimally invasive surgery. Increased competition has the potential to bring value to surgical patients by stimulating innovation and driving down cost. The impact of these platforms remains to be determined, but the continued growth of robotic surgery seems to be all but assured.

Defining digital surgery: a SAGES white paper

BACKGROUND

Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas.

METHODS

This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology.

RESULTS

In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth.

CONCLUSION

Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.

Comparison of 2D and autostereoscopic 3D visualization during mixed reality simulation

PURPOSE

In general minimally invasive surgical procedures, surgeons are tied to 2D visualization, leading to the loss of depth perception. This can lead to large mental load for the surgeons and may be responsible for the long learning curve. To restore the sense of depth, this study investigated the use and benefits of an autostereoscopic (3D) display during a simulated laparoscopic task.

METHODS

A mixed reality simulator was developed for comparing the performance of participants while using 2D and autostereoscopic 3D visualization. An electromagnetic sensor was mounted on a physical instrument, and its pose was mapped to the virtual instrument. The virtual scene was developed using Simulation Open Framework Architecture (SOFA). Finite element modeling was used to calculate interaction forces, which were then mapped to visual soft tissue deformation.

RESULTS

Ten non-expert participants completed a virtual laparoscopic task, where the subjects were asked to contact eighteen target areas distributed on the surface of the vagina, both in 2D and 3D. Results showed an improvement with 3D vision in task completion time (-16%), total traveled distance (-25%) and errors made (-14%). There was no difference in the average contact forces between the vagina and the instrument. Only the difference in time and forces were shown to be statistically significant.

CONCLUSION

Overall, autostereoscopic 3D showed superiority over conventional 2D visualization. The traveled trajectory increased in 2D as the instrument was retracted more between the targets to avoid contact. The 2D and 3D deformation upon contact seems not to contribute differently to force perception. However, the participants only had visual feedback, but no haptic feedback. Therefore, it could be interesting to include haptic feedback in a future study.

Two- and three-dimensional laparoscopic donor nephrectomy: a comparative study of a single-center experience

Background

This is the first report on three-dimensional (3D) laparoscopic donor nephrectomy performed in the Central Asian region and Commonwealth of Independent States countries. This study presents the results of our initial experiences of 3D hand-assisted laparoscopic donor nephrectomy (3D-HALDN) in comparison with the outcomes of two-dimensional hand-assisted laparoscopic donor nephrectomy (2D-HALDN) at a single center.

Methods

From 2015 to 2019, 19 3D-HALDN and 19 2D-HALDN procedures were performed at the same center by two surgeons. All 38 procedures used identical techniques. Between-group differences were considered statistically significant at P<0.05.

Results

The baseline characteristics in both groups were statistically comparable (P>0.05). All donors underwent left nephrectomy. Donors who underwent 3D-HALDN had better outcomes than those who underwent 2D-HALDN, as shown by a shorter warm ischemic time (P<0.05), a shorter operative time (P<0.05), and less blood loss (P<0.05). There were no conversions or major complications (according to the Clavien-Dindo classification) in either group. The average drainage duration and postoperative hospitalization were significantly shorter in the 3D-HALDN group (P<0.05). The between-group differences in the mean postoperative creatinine level and glomerular filtration rate were not significant.

Conclusions

The 3D-HALDN approach is more beneficial than traditional 2D-HALDN by providing a shorter warm ischemic time, less blood loss, and shorter durations of drainage and postoperative hospitalization. Postoperative complications and the functional condition of the kidney in donors in the early and late postoperative periods did not depend on the type of laparoscopic donor nephrectomy.

Three-dimensional versus two-dimensional endoscopes in anatomical orientation of the middle ear and in simulated surgical tasks

Background

Three-dimensional endoscopes provide a stereoscopic view of the operating field, facilitating depth perception compared to two-dimensional systems, but are not yet widely accepted. Existing research addresses performance and preference, but there are no studies that quantify anatomical orientation in endoscopic ear surgery.

Methods

Participants (n = 70) were randomised in starting with either the two-dimensional or three-dimensional endoscope system to perform one of two tasks: anatomical orientation using a labelled three-dimensional printed silicone model of the middle ear, or simulated endoscopic skills. Scores and time to task completion were recorded, as well as self-reported difficulty, confidence and preference.

Results

Novice surgeons scored significantly higher in a test of anatomical orientation using three-dimensional compared to two-dimensional endoscopy (p < 0.001), with no significant difference in the speed of simulated endoscopic skills task completion. For both tasks, there was lower self-reported difficulty and increased confidence when using the three-dimensional endoscope. Participants preferred three-dimensional over two-dimensional endoscopy for both tasks.

Conclusion

The findings demonstrate the superiority of three-dimensional endoscopy in anatomical orientation, specific to endoscopic ear surgery, with statistically indistinguishable performance in a skills task using a simulated trainer.

Gender benefit in laparoscopic surgical performance using a 3D-display system: data from a randomized cross-over trial

BACKGROUND

The use of 3D technique compared to high-resolution 2D-4K-display technique has been shown to optimize spatial orientation and surgical performance in laparoscopic surgery. Since women make up an increasing amount of medical students and surgeons, this study was designed to investigate whether one gender has a greater benefit from using a 3D compared to a 4K-display system.

METHODS

In a randomized cross-over trial, the surgical performance of male and female medical students (MS), non-board certified surgeons (NBCS), and board certified surgeons (BCS) was compared using 3D- vs. 4K-display technique at a minimally invasive training parkour with multiple surgical tasks and repetitions.

RESULTS

128 participants (56 women, 72 men) were included. Overall parkour time in seconds was 3D vs. 4K for all women 770.7 ± 31.9 vs. 1068.1 ± 50.0 (p < 0.001) and all men 664.5 ± 19.9 vs. 889.7 ± 31.2 (p < 0.001). Regarding overall mistakes, participants tend to commit less mistakes while using the 3D-vision system, showing 10.2 ± 1.1 vs. 13.3 ± 1.3 (p = 0.005) for all women and 9.6 ± 0.7 vs. 12.2 ± 1.0 (p = 0.001) for all men. The benefit of using a 3D system, measured by the difference in seconds, was for women 297.3 ± 41.8 (27.84%) vs. 225.2 ± 23.3 (25.31%) for men (p = 0.005). This can be confirmed in the MS group with 327.6 ± 65.5 (35.82%) vs. 249.8 ± 33.7 (32.12%), p = 0.041 and in the NBCS group 359 ± 52.4 (28.25%) vs. 198.2 ± 54.2 (18.62%), p = 0.003. There was no significant difference in the BCS group.

CONCLUSION

3D laparoscopic display technique optimizes surgical performance compared to the 2D-4K technique for both women and men. The greatest 3D benefit was found for women with less surgical experience. As a possible result of surgical education, this gender specific difference disappears with higher grade of experience. Using a 3D-vision system could facilitate surgical apprenticeship, especially for women.

Three-dimensional high-definition exoscope (Kestrel View II) in anterior cervical discectomy and fusion: a valid alternative to operative microscope-assisted surgery

BACKGROUND

Operative microscope (OM) has greatly advanced modern spine surgery, but remains limited by several drawbacks. Therefore, a three-dimensional (3D) high-definition (HD) exoscope (EX) (Kestrel View II, Mataka Kohli, Japan) system has been developed and used as an alternative to the OM. The aim of this study was to assess and compare the perioperative data and clinical outcomes of anterior cervical discectomy and fusion (ACDF) procedure with either an EX or OM.

METHODS

Forty-eight patients with cervical spondylotic myelopathy (CSM) underwent ACDF assisted by the EX or OM between January 2019 and December 2019. We collected and compared data on operative time, intraoperative bleeding, postoperative hospitalization stay, complications, and clinical outcomes between the two groups. The clinical outcomes were evaluated by using visual analogue scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, the recovery rate of JOA scores, and Odom criteria.

RESULTS

The operative time in the EX group was significantly shorter than that in the OM group (P < 0.05). The VAS and JOA scores were significantly improved in both groups after surgery (P < 0.05). In addition, the VAS scores in the EX group were significantly lower than those in the OM group at 1 week postoperatively (P < 0.05). The good-to-excellent outcome rates were 90.48 and 88.89% in the EX group and OM group, respectively, whereas the complication occurrence rates of the EX group and OM group were 4.76 and 11.11%, respectively.

CONCLUSIONS

EX-assisted and OM-assisted ACDF resulted in similar clinical outcomes for CSM, while EX-assisted surgery may be related to a short operative time and fewer complications.

The User Experience on a 3-Dimensional Heads-Up Display for Vitreoretinal Surgery Across All Members of the Health Care Team: A Survey of Medical Students, Residents, Fellows, Attending Surgeons, Nurses, and Anesthesiologists

Purpose:

This work assesses the educational use of a 3-dimensional (3D) heads-up visualization system for vitreoretinal surgery.

Methods:

A cross-sectional survey was performed among 18 medical students, 18 residents, 7 VR fellows, 6 nurses, 4 anesthesiologists, and 3 surgeons on their experience with the Ngenuity 3D Visualization System (TrueVision and Alcon) compared with the standard microscope.

Results:

Most medical students (88%) reported better identification of surgical landmarks; 63% ranked the Ngenuity as their preferred method of learning (vs microscope or 2-dimensional display). Residents reported a superior understanding of anatomy (69%), an increased ability to ask questions (63%), and improved ergonomics (94%). Epiretinal membrane peel, internal limiting membrane peel, and core vitrectomy were most enhanced (69% to 77%) for residents. Fellows’ experience with trocar placement, vitrectomy, and oil/gas insertion was the same as before (67% to 100%), whereas endolaser and closing were worse (67% to 100%). Regarding autonomy, 83% of fellows reported no change, whereas 17% reported increased levels. Nurses were better able to track case progress (67%) and anticipate which tools were needed (50%). All anesthesiologists reported the same or worse engagement in cases, noting it was difficult to switch between the 3D screen and the anesthesia equipment. All surgeons reported a better awareness of trainees in the room and an improved ability to point out landmarks; 67% reported being more comfortable with resident and fellow autonomy.

Conclusions:

The Ngenuity is most helpful to students and residents. Integrating 3D displays into the surgical curriculum is beneficial, with care to ensure nurse and anesthesiologist satisfaction.

3D Exoscope System in Neurosurgery-Comparison of a Standard Operating Microscope With a New 3D Exoscope in the Cadaver Lab

BACKGROUND

For decades, the operating microscope has been the "gold standard" visualization device in neurosurgery. The development of endoscopy revolutionized different surgical disciplines, whereas in neurosurgery, the endoscope is commonly used as an additional device more than as single visualization tool. Invention of a 3D exoscope system opens new possibilities in visualization and ergonomics in neurosurgery.

OBJECTIVE

To assess the prototype of a 3D exoscope (3D exoscope, year of manufacture 2015, FA Aesculap, Tüttlingen, Germany) as neurosurgical visualization device in comparison to a standard operating microscope.

METHODS

A pterional approach was performed in 3 ETOH-fixed specimens (6 sides). A standard operating microscope was compared to a 3D exoscope prototype. Dimensions like visual field, magnification, illumination, ergonomics, depth effect, and 3D impression were compared.

RESULTS

In all approaches, the structures of interest could be clearly visualized with both devices. Magnification showed similar results. The exoscope had more magnification potential, whereas the visual quality got worse in higher magnification levels. The illumination showed better results in the microscope. Surgeons felt more comfortable with the 3D exoscope, concerning ergonomic considerations. Depth effect and 3D impression showed similar results. None of the surgeons felt uncomfortable using the exoscope.

CONCLUSION

The operating microscope is the gold standard visualization tool in neurosurgery because of its illumination, stereoscopy, and magnification. Nevertheless, it causes ergonomic problems. The prototype of a 3D exoscope showed comparable features in visual field, stereoscopic impression, and magnification, with a clear benefit concerning the ergonomic possibilities.

Comparison of two-dimensional high-definition, ultra high-definition and three-dimensional endovision systems: an ex-vivo randomised study

BACKGROUND

Two-dimensional high-definition (2D HD) endovision system is preferred for laparoscopic surgery. Recently, new generation three-dimensional (3D) HD and ultra-HD (4K) endovision systems are introduced to improve the safety and efficacy of laparoscopic surgery. There is limited evidence on superiority of one technology over the others. This experimental trial was designed to evaluate 2D HD, 3D HD and 4K HD endovision systems in performance of standardized tasks.

METHODS

This was a randomized, cross-over experimental study. Twenty-one surgical residents who were exposed to laparoscopic surgery were enrolled. Participants were randomly assigned into three groups. Each group performed standardised tasks i.e. peg transfer, precision cutting, navigating in space and intra-corporeal suturing using 2D HD, 4K HD and 3D HD endovision systems on a box trainer. Procedures were recorded as 2D HD videos and analysed later. Participant's perceived workload was assessed using Surg-TLX questionnaire. Primary endpoints were execution time in seconds and error score. Secondary endpoint was workload assessment.

RESULTS

The 3D HD had shorter execution time compared to 2D HD and 4K HD in all tasks except precision cutting (p = 0.004, 0.03, 0.001, 0.001 and p = 0.002, 0.191, 0.006, 0.005 in peg transfer, precision cutting, navigating in space and intra-corporeal suturing respectively). The 4K HD was significantly faster than 2D HD only in navigating in space task (p = 0.002). The error score between 3D HD and 4K HD were comparable in all tasks. The 2D HD had significantly more error scores compared to 4K HD, 3D HD in peg transfer task (p = 0.005, 0.014, respectively). 3D HD had significantly less workload than 2D HD and 4K HD in most of the dimensions of Surg-TLX CONCLUSIONS: 3D HD endovision system in comparison to 2D HD and 4K HD, may lead to faster execution without compromising safety of a task and is associated with less workload.

Applicability and Effectiveness of Laparoscopic Procedures in Pediatrics

Background: Three-dimensional (3D) laparoscopic surgery in pediatrics is still uncommon and few studies assessed in clinical practice advantages and disadvantages. Applicability and effectiveness of 3D versus two-dimensional (2D) laparoscopic procedures in congenital and acquired conditions in children are still unknown. We assessed applicability and effectiveness of 3D compared with 2D laparoscopic procedures in a pediatric setting. Methods: Two groups of patients who underwent 3D or 2D laparoscopic surgical procedures between May 2016 and April 2018 were compared. Each 3D/2D laparoscopic procedure was assessed with a surgeon/assistant questionnaire. Results: The 3D group included 30 patients and the 2D group 32 patients. The analysis of the 3D/2D questionnaire showed statistically significant superiority of 3D technical aspects (P = .0000), allowing a better spatial orientation and depth perception, reducing manipulation and trauma to tissues. Moreover, no difference was reported in physical complaints (P = .7084), but decreased visual fatigue was highlighted by surgeon (P = .000). Conclusions: In pediatric patients, 3D laparoscopic procedures prove to be more effective facilitating the surgeon's performance, while maintaining the benefits of minimally invasive surgery.

Protocol for enhanced recovery after surgery with 3D laparoscopic excision for choledochal cysts can benefit the recovery process

OBJECTIVE

To explore the clinical value of enhanced recovery after surgery (ERAS) with laparoscopic choledochal cyst (CDC) excision in children.

METHODS

A retrospective review was performed on the clinical data from 33 in-patients whose final diagnosis was CDC. We included 18 patients who underwent the traditional treatment for CDC from April 2017 to October 2017 as the control group and 15 patients who underwent the enhanced recovery protocol (ERP) from November 2017 to May 2018 as the ERAS group. All the patients had received three-dimensional (3D) laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy by the same group of pediatric surgeons. The time of initial water intake, postoperative time to total enteral nutrition (TEN), postoperative hospital stay, total cost in hospital, postoperative complications, and readmission rate within 30 days were analysed.

RESULTS

The postoperative time of initial water intake, postoperative time to TEN, postoperative hospital stay, and total cost in hospital were (21.5 ± 2.1) h, (4.3 ± 0.5) days, (5.3 ± 0.6) days, and (35,945.49 ± 6071.46) China Yuan (CNY) in the ERAS group and (44.1 ± 3.5) h, (7.7 ± 2) days, (9.1 ± 2.5) days, and (45,609.08 ± 11,439.80) CNY in the control group, respectively. These values in the ERAS group were significantly lower than those in the control group (p < 0.05). There was no significant difference between the two groups in terms of postoperative complications. No readmission patient within 30 days was encountered in either of the two groups.

CONCLUSION

Enhanced recovery protocols can shorten postoperative hospital stay, relieve perioperative discomfort, lighten the financial burden, and result in substantial improvements.

Early Experience, Setup, Learning Curve, Benefits, and Complications Associated with Exoscope and Three-Dimensional 4K Hybrid Digital Visualizations in Minimally Invasive Spine Surgery

Study Design

Prospective observational study (n=74).

Purpose

To evaluate the learning curve for exoscope and three-dimensional (3D) 4K hybrid visualization in terms of operating time, advantages, disadvantages, and surgical complications in tubular-access minimally invasive spine surgery (MISS) and to assess surgeon satisfaction with image quality, ergonomics, and ability to perform target site treatment.

Overview of Literature

Working through tubular retractors poses a challenge. The extreme angulations during microsurgical decompression, especially contralateral decompression, require surgeons to work non-ergonomically. An exoscope allows surgeons to work ergonomically and independently of the microscope oculars as visualizations are now provided by large 3D 4K monitors. However, the value and efficacy of solely depending on an exoscope and 3D 4K monitors during microsurgical work are still unknown.

Methods

Seventy-four patients (99 levels) underwent trans-tubular MISS between March 2018 and January 2019. Five patients were excluded: one had pyogenic discitis, two had revisions, and two were trans-tubular transoral. In total, we analyzed 69 for operating time, blood loss, and complications. The learning curve graph was plotted using the surgical time for each procedure. Surgeons were asked to rate their satisfaction with image quality, ability to maintain ergonomic posture, and efficient target site treatment.

Results

For tubular microdiscectomy, the operating time plateaued after six cases, and for tubular decompression and minimally invasive transforaminal lumbar interbody fusion, the operating time plateaued after nine cases. Mean operating time was significantly reduced after the plateau. Complications included four cases of dural tear. All patients improved symptomatically, and there were no postoperative neurological deficits.

Conclusions

Use of the exoscope has a short learning curve. Surgeons benefit from improved ergonomic posture during surgery, and resident teaching appears to be good. The only drawback is the need to rearrange the operating table setup. Complications were comparable to those when using the surgical microscope. An exoscope with hybrid digital visualization provides excellent visualization, depth perception, clarity, and precision target site treatment.

Comparison of Three- and Two-Dimensional Laparoscopy in Pediatric Nissen Fundoplication

Aim: This study aimed to evaluate the usefulness of three-dimensional (3D) versus conventional two-dimensional (2D) vision in pediatric laparoscopic Nissen fundoplication. Materials and Methods: Medical records and procedure videos of patients 18 years old or younger who underwent laparoscopic Nissen fundoplication at a single institution between January 2015 and August 2018 were retrospectively reviewed. The total pneumoperitoneum and wrapping times were measured. The number of errors during the first stitch of the wrapping was counted. Three-dimensional laparoscopy was introduced in January 2017, and data were compared between the previous 2D and current 3D groups. A questionnaire was provided to each surgeon who performed the 3D procedure. Results: Laparoscopic fundoplication was performed under 2D vision in 32 patients and under 3D vision in 19 patients. Mean ages and weights at surgery were similar between the groups. There was no significant differences in pneumoperitoneum and wrapping times between the two groups. Significantly more errors were counted in the 2D versus 3D procedure, but all patients recovered without any complications related to intraoperative errors. On the questionnaires, all 8 surgeons desired a decreased scope diameter and multidirectional visual axis. Four surgeons (50%) experienced eyestrain and 1 experienced double vision. Conclusions: This study showed no reduction in surgical time with 3D versus 2D scope use. Three-dimensional vision decreased the technical errors in creating the wrap, but its clinical merit remains unclear. Decreasing the scope diameter and adding multidirectional vision capabilities are needed for the 3D scope to gain more widespread approval and use in pediatric surgery.

Current status of simulation-based training in pediatric surgery: A systematic review

BACKGROUND

Simulation based training enables pediatric surgical trainees to attain proficiency in surgical skills. This study aims to identify the currently available simulators for pediatric surgery, assess their validation and strength of evidence supporting each model.

METHODS

Both Medline and EMBASE were searched for English language articles either describing or validating simulation models for pediatric surgery. A level of evidence (LoE) followed by a level of recommendation (LoR) was assigned to each validation study and simulator, based on a modified Oxford Centre for Evidence-Based Medicine classification for educational studies.

RESULTS

Forty-nine articles were identified describing 44 training models and courses. Of these articles, 44 were validation studies. Face validity was evaluated by 20 studies, 28 for content, 24 demonstrated construct validity and 1 showed predictive validity. Of the validated models, 3 were given an LoR of 2, 21 an LoR of 3 and 12 an LoR of 4. None reached the highest LoR.

CONCLUSIONS

There are a growing number of simulators specific to pediatric surgery. However, these simulators have limited LoE and LoR in current studies. The lack of NoTSS training is also apparent. We advocate more randomized trials to validate these models, and attempts to determine predictive validity.

TYPE OF STUDY

Original / systematic review.

LEVEL OF EVIDENCE

1.

Stereoscopic versus monoscopic displays: Learning fine manual dexterity skills using a microsurgical task simulator

We investigated the learning of fine manual dexterity with a microsurgical instrument and a new simulator in a context of microsurgery. 30 subjects were divided into two groups. One (3D group) interacted with a stereoscopic and the other (2D group) with a monoscopic display. Visual information for the displays was captured from a surgical stereomicroscope. In 20 trials, both groups performed the repetitive tasks of picking up small rods from a funnel-shaped cavity and placing them outside. In analysing learning curves, we found that the initial learning process for hand-eye coordination is easier with a 3D display, and that performance persists at a higher level of proficiency than with the 2D display option. Thus stereoscopic displays can be especially beneficial for novices, for those learning new procedures, or for providing orientation to operators facing a new or altered spatial situation. Simulators with few reliefs or spatial textures should not be used for comparison between 3D and 2D viewing conditions.

The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018

BACKGROUND

The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community.

METHODS

Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018.

RESULTS

9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I² 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I² 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I² 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D.

CONCLUSION

We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).

The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018

BACKGROUND

The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community.

METHODS

Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018.

RESULTS

9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I² 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I² 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I² 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D.

CONCLUSION

We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).

The Preliminary Experiences with Three-Dimensional Heads-Up Display Viewing System for Vitreoretinal Surgery under Various Status

Statement: The current article has not been published elsewhere and has not been submitted simultaneously for publication elsewhere.

PURPOSE

To investigate the preliminary use of three-dimensional (3D) heads-up display (HUD) viewing system for vitreoretinal surgery under various status.

MATERIALS AND METHODS

Nonrandomized case-control study. Consecutive cases to have vitreoretinal surgery under various status were prospectively recruited. Twenty-five-gauge vitrectomy platform and 3D viewing system were used. Main outcomes included: luminous emittance (lux) of endoillumination pipe, surgical duration, the surgeon and residents' preference and ergonomics. Consecutive patients to have vitreoretinal surgery with the conventional viewing system were recruited as control group following the same inclusion and exclusion criteria and underwent surgeries by the same surgeon with the same microscope and vitrectomy platform.

RESULTS

Thirty-one patients (31 eyes; Group Study) and twenty-eight patients (28 eyes; Group Control) were included; without significantly statistical difference in terms of age, gender, main diagnosis, surgical duration, and difficulty rating between both groups (all P > 0.05). Lower endoillumination intensity was needed in Group Study than that in Group Control (10% vs. 35%; 598.7 ± 5.4 vs. 1913.0 ± 12.9 lux, P < 0.001). The surgeon and residents expressed overwhelming preference with the 3D system in both groups. Improved ergonomic was rated in Group Study (4.4 ± 0.8 vs. 3.2 ± 1.0, P < 0.001). Some intraoperative difficulties and discomforts appeared to the surgeon and assistants when using the 3D viewing system.

CONCLUSION

Vitreoretinal surgery under various status can be well finished with the HUD platform by novice at the system. Main benefits included lower endoillumination intensity, enhanced users' preference, and improved ergonomics. Some further refinements of the system are expected.

A Suggestion on How to Compare 2D and 3D Laparoscopy: A Qualitative Analysis of the Literature and Randomized Pilot Study

BACKGROUND AND AIMS

The results of studies comparing two-dimensional (2D) and three-dimensional (3D) laparoscopy have shown variable results. We aimed to review the literature and develop an appropriate instrument to compare 2D and 3D laparoscopy. We further aimed to use the data extracted to perform a pilot study.

METHODS

Sixty-seven recent articles on 3D laparoscopy were reviewed and data extracted on factors influencing outcome variables. These variables were used to design a pilot study of 28 novices using a randomized crossover design. The results were analyzed using descriptive statistics and the Wilcoxon signed-rank tests.

RESULTS

Seven themes were identified to influence the outcome of 3D studies: applied technique (1), experience of subjects (2), study design (3), learning curve (4), subjective qualitative reports (5), laparoscopic tasks (6), and chosen outcome variables (7). The consecutively developed five laparoscopic simulation tasks contained placing a rubber band over hooks, ring and pearl transfer, threading a pipe cleaner through loops, and placing a suturise. The pilot study showed a primary benefit of 3D laparoscopy that was unrelated to repetition. Two tasks served well to assess first-time performance, and two tasks promise to serve well to assess a learning curve if performed repeatedly.

CONCLUSION

We were able to identify important issues influencing the outcome of studies analyzing 3D laparoscopy. These may help evaluate future studies. The developed tasks resulted in meaningful data in favor of 3D visualization, but further studies are necessary to confirm the pilot test results.