Reasonable Collocation of Two Different Functional 3D Laparoscopes May Improve the Efficiency of Transanal Total Mesorectal Excision Surgery Using a Synchronous Two-Team Approach?

Background: To investigate the effectiveness of two different functional three-dimensional (3D) laparoscopes in transanal total mesorectal excision (taTME). Methods: We retrospectively analyzed clinical data of 106 patients undergoing taTME of rectal cancer at the Affiliated Nanchong Central Hospital of North Sichuan Medical College between August 2017 and July 2020. Fifty-seven patients used the flexible 3D laparoscope (FTDL) and 49 patients used the rigid 3D laparoscope (RTDL). Results: Transabdominal operation duration in the FTDL group was shorter than in the RTDL group (125.5 ± 52.6 minutes versus 148.8 ± 59.3 minutes, P = .034). However, transanal operation duration in the FTDL group was longer than in the RTDL group (77.3 ± 26.8 minutes versus 104.6 ± 34.1 minutes, P = .000). There were no significant differences between the two groups in the number of harvested lymph nodes, total operation duration, postoperative complications, postoperative hospitalization, and quality of mesorectal specimen (P > .05). Conclusion: Synchronous two-team approach can be widely used in taTME. Making full use of the respective advantages of the two 3D laparoscopes is beneficial to improve the efficiency of taTME surgery. Clinical Trial Registration Number: NCT03416699.

Safety of Three-Dimensional versus Two-Dimensional Laparoscopic Hysterectomy during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has resulted in a significant decrease in the number of surgical procedures performed. Therefore, it is important to use surgical methods that carry the lowest possible risk of virus transmission between the patient and the operating theater staff.

AIM

Safety evaluation of three-dimensional (3D) versus two-dimensional (2D) laparoscopic hysterectomy during the COVID-19 pandemic.

METHODS

44 patients were assigned to a prospective case-control study. They were divided either to 3D (n = 22) or 2D laparoscopic hysterectomy (n = 22). Fourteen laparoscopic supracervical hysterectomies (LASH) and eight total laparoscopic hysterectomies (TLH) were performed in every group. The demographic data, operating time, change in patients' hemoglobin level and other surgical outcomes were evaluated.

RESULTS

3D laparoscopy was associated with a significantly shorter operating time than 2D. (3D vs. 2D LASH 70 ± 23 min vs. 90 ± 20 min, p = 0.0086; 3D vs. 2D TLH 72 ± 9 min vs. 85 ± 9 min, p = 0.0089). The 3D and 2D groups were not significantly different in terms of change in serum hemoglobin level and other surgical outcomes.

CONCLUSIONS

Due to a shorter operating time, 3D laparoscopic hysterectomy seems to be a safer method both for both the surgeon and the patient. Regarding terms of possible virus transmission, it may be particularly considered the first-choice method during the COVID-19 pandemic.

Refinement of recto-sigmoid colon vaginoplasty using a three-dimensional laparoscopic technique

To investigate the feasibility, safety, and outcomes of three-dimensional (3D) laparoscopic vaginoplasty with a rectosigmoid colon flap for vaginal reconstruction.Following appropriate preoperative patient counseling, 17 consecutive patients underwent vaginoplasty using a 3D laparoscopic system. Perioperative and postoperative outcomes were retrospectively evaluated.Between September 2016 and February 2020, 17 patients underwent 3D laparoscopic vaginoplasty with a rectosigmoid colon flap. Of them, 15 (88%) were transgender female patients, and 2 (12%) were cisgender female patients with congenital deformities. Among the 15 transgender patients, 12 (80%) underwent de novo surgeries and 3 (20%) underwent re-do surgeries. The mean age at the time of operation was 33.0 years, and the mean total operation time was 529 ± 128 minutes. The initial intraoperative mean vaginal depth was 15.2 ± 1.3 cm, and the 30-day readmission rate was 5.9% (1/17 cases). The mean follow-up duration was 24.8 months.Perioperative and postoperative outcomes suggest that 3D laparoscopic rectosigmoid colon vaginoplasty is a potentially acceptable, effective, and safe method for vaginal reconstruction.

Comparison of Perioperative, Oncological, and Functional Outcomes of Three-Dimensional Versus Robot-Assisted Laparoscopic Radical Prostatectomy: A Preliminary Study

Background: Radical prostatectomy (RP) is the first-line treatment modality for prostate cancer and can be performed using retropubic or minimally invasive techniques. New technologies such as the da Vinci robotic system and three-dimensional (3D) laparoscopic imaging system have been developed to overcome the challenges of conventional laparoscopy. This study aimed to compare the perioperative, oncological, and functional outcomes of robot-assisted laparoscopic RP (RALP) and 3D laparoscopic RP (3D LRP). Materials and Methods: The study was approved by the local ethics committee and included 65 patients (38 RALP, 27 3D LRP) who underwent RP with the diagnosis of localized prostate cancer between May 2019 and January 2020. All demographic, clinical, perioperative, pathological, and postoperative variables were recorded. Results: There was no statistically significant difference between the two groups in terms of preoperative patient characteristics. The mean operative times of the RALP and 3D LRP groups were 135.74 ± 11.51 and 165.37 ± 15.86 minutes, respectively, with a statistically significant difference between the two groups (P = .001). The mean estimated blood loss was 237 ± 71 mL in the RALP group and 257 ± 54 mL in the 3D LRP group, with no statistically significant difference between the two groups (P = .236). In the 6 months of follow-up, there was no statistically significant difference between the two groups in terms of biochemical recurrence, continence, and potency. Conclusion: RALP and 3D LRP have similar perioperative, short-term oncological and functional outcomes other than the operative time. There is a need for prospective, randomized studies with larger populations evaluating long-term oncological and functional outcomes.

Augmented Reality Navigation for Stereoscopic Laparoscopic Anatomical Hepatectomy of Primary Liver Cancer: Preliminary Experience

Background

Accurate determination of intrahepatic anatomy remains challenging for laparoscopic anatomical hepatectomy (LAH). Laparoscopic augmented reality navigation (LARN) is expected to facilitate LAH of primary liver cancer (PLC) by identifying the exact location of tumors and vessels. The study was to evaluate the safety and effectiveness of our independently developed LARN system in LAH of PLC.

Methods

From May 2018 to July 2020, the study included 85 PLC patients who underwent three-dimensional (3D) LAH. According to whether LARN was performed during the operation, the patients were divided into the intraoperative navigation (IN) group and the non-intraoperative navigation (NIN) group. We compared the preoperative data, perioperative results and postoperative complications between the two groups, and introduced our preliminary experience of this novel technology in LAH.

Results

There were 44 and 41 PLC patients in the IN group and the NIN group, respectively. No significant differences were found in preoperative characteristics and any of the resection-related complications between the two groups (All P > 0.05). Compared with the NIN group, the IN group had significantly less operative bleeding (P = 0.002), lower delta Hb% (P = 0.039), lower blood transfusion rate (P < 0.001), and reduced postoperative hospital stay (P = 0.003). For the IN group, the successful fusion of simulated surgical planning and operative scene helped to determine the extent of resection.

Conclusions

The LARN contributed to the identification of important anatomical structures during LAH of PLC. It reduced vascular injury and accelerated postoperative recovery, showing a potential application prospects in liver surgery.

Learning Laparoscopic Surgery Skills With a 4K Ultra-High Definition 2D vs a Three-Dimensional HD Laparoscopic System: Results From a Prospective Randomized Trial

Background. In minimally invasive surgery (MIS), the loss of stereoscopic depth perception in a two-dimensional (2D) representation is most challenging. Recently introduced 4K ultrahigh definition (UHD) 2D optical systems could potentially facilitate the learning and use of compensation mechanisms for the loss of depth perception. However, the role of the new 4K technology against three dimensional (3D) in learning and implementation of MIS remains unknown. The aim of this trial was to determine the influence of 4K UHD 2D vs 3D HD representation on the acquisition of MIS skills. Methods. This was a prospective randomized study involving 62 MIS-inexperienced study participants. We compared a laparoscopic 4K UHD 2D (system A) vs a laparoscopic 3D HD system (system B) for differences in learning MIS skills using the Lübeck Toolbox (LTB) video box trainer. We evaluated participants' performance regarding the repetitions required to reach the goal of each LTB task. Results. Comparing systems A and B, participants using the laparoscopic 3D system required fewer repetitions to achieve goals of LTB tasks No. 1 (P = .0048) and No. 3 (P = .0014). In contrast, for LTB tasks No. 2 and No. 4, no significant difference could be determined between both groups. Conclusion. Our results indicated that MIS basic skills can be learned quicker using a 3D HD system vs a 4K UHD 2D system. However, for MIS tasks in confined spaces, the learning speed with 4K UHD 2D imaging seems to be comparable to a 3D HD system.

Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis

Objective: The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. Methods: A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. Results: A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Conclusions: Three-dimensional laparoscopic systems essentially advance surgical performance in less-experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.

Laparoscopy for living donor left nephrectomy: Comparison of three-dimensional and two-dimensional vision

The main objective of this preliminary study was to evaluate the feasibility and safety of 3-D laparoscopic living donor left nephrectomy (LDLN). The secondary objective was to compare intraoperative and postoperative outcomes between 3-D and 2-D laparoscopic LDLN. All patients who underwent a laparoscopic LDLN from January 2015 to April 2018 in a university center were included. All surgeries were performed by three experienced surgeons. Seventy three patients were included the following: 16 underwent a 3-D laparoscopic LDLN (3-D group), and 57 underwent a 2-D laparoscopic LDLN (2-D group). Operative time and warm ischemia time (WIT) were significantly lower in the 3-D group (operative time: 80.9 ± 10.2 vs 114.1 ± 32.3 minutes in the 3-D and 2-D groups, P = .0002) (WIT: 1.7 ± 0.6 vs 2.3 ± 0.9 minutes in the 3-D and 2-D groups, P = .02). No conversion to open surgery occurred in both groups. Length of hospital stay was significantly shorter in the 3-D group. No major postoperative complications (Clavien ≥ III) occurred. One-year postoperative GFR was similar to 3-D and 2-D groups. Our preliminary study demonstrates that 3-D laparoscopic LDLN is a feasible and safe surgical procedure. Intraoperative and postoperative outcomes were similar in both 2-D and 3-D vision systems, but 3-D vision systems allow reduction in WIT and operative time.

Two-Dimensional Versus Three-Dimensional Laparoscopic Systems in Urology: A Systematic Review and Meta-Analysis

BACKGROUND

Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the three-dimensional (3D) laparoscopic system in comparison with two-dimensional (2D) laparoscopy for treatment of different urological conditions.

METHODS

Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in Web of Science, PubMed, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2018. Articles published in the English language of both randomized and observational studies comparing 3D and 2D laparoscopic systems in urological surgeries were included. Level of evidence and quality assessments of all included studies were conducted. Interested data were extracted for comparison and meta-analysis.

RESULTS

Our literature search generated 17 studies comparing 3D and 2D laparoscopic systems in different urological surgeries. Of these, 13 studies containing 548 and 449 patients operated on with 2D and 3D laparoscopic systems, respectively, were included for meta-analysis. These 13 studies were divided into three groups according to surgical type. Group 1: Partial nephrectomy (PN); operative time (p = 0.19), estimated blood loss (EBL) (p = 0.51), dissecting time (p = 0.58), and suturing time (p = 0.28) were not statistically significant between 2D and 3D laparoscopic systems. However, warm ischemia time during PN was significantly shorter during 3D laparoscopy (p < 0.00001). Group 2: Pyeloplasty; this procedure showed no significant difference between the two systems. Group 3: Radical prostatectomy (RP); shorter operative time (p < 0.0001) and lower EBL (p = 0.001) were associated with the 3D laparoscopic system.

CONCLUSION

Three-dimensional laparoscopy mainly improves the depth of perception, leading to better visibility, which is important for some complex urological surgeries such as PN, pyeloplasty, and RP. Based on our findings, 3D laparoscopy seems to provide better clinical and surgical outcomes in some urological procedures compared with conventional 2D laparoscopy.

[Comparison the clinical efficacy of 3D versus 2D total laparoscopic thyroidectomy for thyroid cancer by via-breast approach]

Objective:To summarize and analyze the clinical efficacy of 3D and 2D laparoscopic surgery in thyroidectomy for thyroid cancer. Method: Thirty-seven patients with early-differentiated thyroid cancer underwent laparoscopic surgery from August 2016 to November 2018. Their clinical data were retrospectively analyzed. They were divided into 3D laparoscopic group and 2D laparoscopic group based on laparoscopic imaging systems. The perioperative clinical indicators and postoperative complications of the two groups were compared. Result: Compared with the 2D laparoscopic group, the 3D laparoscopic group had shorter operation time and less bleeding, and the incidence of postoperative complications was less, but the differences between the two groups were not statistically significant(P>0.05). Conclusion: Compared with the 2D laparoscopic thyroidectomy, 3D laparoscopic thyroidectomy for thyroid cancer allows higher surgical precision, shorter operation time, lower operation risk and smoother surgical procedure, thus improves surgical efficiency.

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.

Comparing short-time outcomes of three-dimensional and two-dimensional totally laparoscopic surgery for colon cancer using overlapped delta-shaped anastomosis

Purpose

Overlapped delta-shaped anastomosis is a newly developed intracorporeal procedure in totally laparoscopic surgery for colon cancer. We explored the safety and efficacy of three-dimensional (3D) totally laparoscopic surgery for colon cancer using overlapped anastomosis and compared its short-term outcomes with those of two-dimensional (2D) surgery.

Materials and methods

From January 2016 to March 2018, 97 colon cancer patients were grouped into the 3D group (43 patients) and the 2D group (54 patients); they underwent totally laparoscopic surgery for colon cancer using overlapped anastomosis by 3D and 2D laparoscopy, respectively. Data regarding the clinical characteristics, surgical and pathological outcomes, postoperative recovery and complications were collected and compared.

Results

These two groups were well balanced in terms of age, gender, body mass index, American Society of Anesthesiologists scores, previous abdominal operation history and preoperative chemotherapy (P>0.05). The overall operation time, intraoperative blood loss and removal method of the specimen were similar between groups (P>0.05), but the anastomosis time was significantly shorter in the 3D group than that in the 2D group (P=0.004). There were no differences in terms of pathological outcomes, postoperative recovery and the postoperative complication rates between the groups (P>0.05). Moreover, no mobility related to the anastomosis, such as anastomotic bleeding, stenosis or leakage, occurred in any patient.

Conclusion

3D totally laparoscopic surgery for colon cancer using overlapped delta-shaped anastomosis is safe and effective, with satisfactory short-term outcomes. In addition, it is less time-consuming than 2D surgery regarding the overlapped anastomosis procedure.

Two-dimensional versus three-dimensional laparoscopy in surgical efficacy: a systematic review and meta-analysis

Background

Laparoscopy is a revolutionary technique in modern surgery. However, the comparative efficacy between two-dimensional laparoscopy and three-dimensional laparoscopy remains in uncertainty. Therefore we performed this systematic review and meta-analysis in order to seek for answers.

Methods

Databases of PubMed, Web of Science, EMBASE and Cochrane Library were carefully screened. Clinical trials comparing two-dimensional versus three-dimensional laparoscopy were included for pooled analysis. Observational and randomized trials were methodologically appraised by Newcastle-Ottawa Scale and Revised Jadad's Scale respectively. Subgroup analyses were additionally conducted to clarify the potential confounding elements. Outcome stability was examined by sensitivity analysis, and publication bias was analyzed by Begg's test and Egger's test.

Results

21 trials were screened out from the preliminary 3126 records. All included studies were high-quality in methodology, except for Bilgen 2013 and Ruan 2015. Three-dimensional laparoscopy was superior to two-dimensional laparoscopy in terms of surgical time (P < 0.00001), blood loss (P = 0.01), perioperative complications (P = 0.04) and hospital stay (P = 0.03). Additionally, both techniques demonstrated comparable results of secondary endpoints, including drainage volume (P = 0.74), drainage time (P = 0.26), numbers of retrieved lymphnodes (P = 0.85), hospital expenses (P = 0.49), anastomosis time in prostatectomy (P=0.15) and 6-month continence rate (P = 0.61). The pooled outcomes of primary endopoints were verified to be stable by sensitivity analysis. Although Begg's test (P = 0.215) and Egger's test (P = 0.003) revealed that there was publication bias across included studies, Trim-and-Fill method confirmed that the results remained stable.

Conclusion

Three-dimensional laparoscopy is a preferably surgical option against two-dimensional laparoscopy due to its better surgical efficacy.

[Efficacy of three-dimensional laparoscopic total thyroidectomy combined with central lymph node dissection for thyroid cancer and its effect on inflammatory responses of the patients]

OBJECTIVE

To analyze the effect of three-dimensional (3D) laparoscopic total thyroidectomy combined with central lymph node dissection for thyroid cancer and its effect on the inflammatory response of the patients.

METHODS

The clinical data were analyzed in 90 patients with thyroid cancer undergoing radical thyroidectomy at our hospital between September, 2013 to April, 2016, including 30 receiving 3D laparoscopic surgeries, 30 with 2D laparoscopic surgeries and 30 with open surgeries. The surgical data, postoperative adverse reactions and the impact of the surgeries on the inflammatory responses of the patients were compared among the 3 groups.

RESULTS

Compared with the open surgery and 2D laparoscopic surgery, 3D laparoscopic surgery was associated with lowered blood loss during the surgery and a lowered incidence of adverse reactions. The operation time in 3D group was significantly shorter than that in 2D group (P<0.05), but the total hospitalization expenses were similar between the two groups. The postoperative drainage volume did not differ significantly between the 3D group and the other two groups. The postoperative hospital stay, number of lymph nodes dissected, positivity rate of lymph nodes and the inflammatory response showed no significant differences among the 3 groups (P>0.05).

CONCLUSION

3D laparoscopic total thyroidectomy combined with central lymph node dissection is safe and effective and reduces intraoperative blood loss and perioperative adverse reactions without significant influence on inflammatory response in patients with thyroid cancer.

[Efficacy of three-dimensional laparoscopic total thyroidectomy combined with central lymph node dissection for thyroid cancer and its effect on inflammatory responses of the patients]

OBJECTIVE

To analyze the effect of three-dimensional (3D) laparoscopic total thyroidectomy combined with central lymph node dissection for thyroid cancer and its effect on the inflammatory response of the patients.

METHODS

The clinical data were analyzed in 90 patients with thyroid cancer undergoing radical thyroidectomy at our hospital between September, 2013 to April, 2016, including 30 receiving 3D laparoscopic surgeries, 30 with 2D laparoscopic surgeries and 30 with open surgeries. The surgical data, postoperative adverse reactions and the impact of the surgeries on the inflammatory responses of the patients were compared among the 3 groups.

RESULTS

Compared with the open surgery and 2D laparoscopic surgery, 3D laparoscopic surgery was associated with lowered blood loss during the surgery and a lowered incidence of adverse reactions. The operation time in 3D group was significantly shorter than that in 2D group (P<0.05), but the total hospitalization expenses were similar between the two groups. The postoperative drainage volume did not differ significantly between the 3D group and the other two groups. The postoperative hospital stay, number of lymph nodes dissected, positivity rate of lymph nodes and the inflammatory response showed no significant differences among the 3 groups (P>0.05).

CONCLUSION

3D laparoscopic total thyroidectomy combined with central lymph node dissection is safe and effective and reduces intraoperative blood loss and perioperative adverse reactions without significant influence on inflammatory response in patients with thyroid cancer.

Three-Dimensional Versus Two-Dimensional Laparoscopic Cholecystectomy: A Systematic Review

BACKGROUND AND AIMS

In the last decades, the three-dimensional (3D) imaging systems have been introduced in an attempt to improve depth perception and image quality during laparoscopic cholecystectomy interventions. The goal of our systematic review was to provide enough convincing evidences on superiority and benefits of 3D over two-dimensional (2D) imaging systems, from both surgeon's and patient's point of view, justifying the cost-effectiveness of newly developed 3D systems.

METHODS

Two authors separately performed a full literature search aiming to find randomized controlled trials evaluating the advantages and disadvantages of 3D versus 2D laparoscopic cholecystectomy procedures. The patients who underwent elective laparoscopic cholecystectomy were included in this study irrespective of their age and sex. Differing opinions between the two authors were reviewed by the third author.

RESULTS

A total of 912 articles were initially reviewed by their titles and abstracts for eligibility. After being filtered through predetermined inclusion and exclusion criteria, and excluding the duplicates, only 10 studies underwent the final evaluation by the full text assessment. Eventually, only five randomized controlled studies were included in this study. Operative time and depth perception/image quality were set as the primary and secondary outcomes, respectively. The operative time was significantly shorter in 60% of the studies. Of five studies that evaluated the depth perception and image quality, all five (100%) reported a better depth perception and image quality.

CONCLUSIONS

3D imaging systems tend to shorten the operative time compared to 2D systems and result in a better depth perception. More studies and investigations with bigger cohort sizes and using unique 3D visual systems are necessary to justify the cost-effectiveness of the new, more expensive 3D systems.