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1
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Kagimoto A, Ishida M, Mimura T. Utility of 4 K three-dimensional endoscopic system in performing video-assisted thoracoscopic surgery lobectomy: initial results of the first year after installation. Gen Thorac Cardiovasc Surg 2024; 72:535-541. [PMID: 38198079 DOI: 10.1007/s11748-023-02004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES With the evolution of technology in the field of thoracoscopy, three-dimensional (3D) endoscopic systems with 4 K resolution have recently come into use. This study aimed to determine perioperative outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy performed a year after the 4 K three-dimensional (3D) endoscopic system installation and compare them with those of the high-definition (HD) 3D endoscopic system. METHODS We included patients who underwent complete VATS (cVATS) lobectomy for primary lung cancer using an HD3D endoscopic system (HD3D group, June 2015-September 2021, n = 251) or 4K3D endoscopic system (4K3D group, October 2021-September 2022, n = 47). The perioperative outcomes were compared between the two groups. RESULTS The operation time was significantly shorter in the 4K3D group (mean, 189.5 min) than in the HD3D group (208.5 min; p = 0.021), and the 4K3D group did not require conversion to thoracotomy or transfusion. The 4K3D group had less blood loss volume (4K3D group: mean, 24.0 mL vs. HD3D group: 43.3 mL; p = 0.105) and shorter chest drainage duration (4K3D group: mean, 2.3 days vs. HD3D group: 3.1 days; p = 0.115) and hospitalization period (4K3D group: mean, 7.9 days vs. HD3D group:10.0 days; p = 0.226) than the HD3D group, with no significant difference. No difference was observed in the incidence of ≥ Grade IIIa complications (p = 0.634). CONCLUSION The 4K3D endoscopic system significantly shortened the duration of cVATS lobectomy. It is useful for lung resection and may replace other endoscopy systems.
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Affiliation(s)
- Atsushi Kagimoto
- Department of General Thoracic Surgery, Kure Medical Center and Chugoku Cancer Center, National Hospital Organization, 3-1, Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan
| | - Masayuki Ishida
- Department of General Thoracic Surgery, Kure Medical Center and Chugoku Cancer Center, National Hospital Organization, 3-1, Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan
| | - Takeshi Mimura
- Department of General Thoracic Surgery, Kure Medical Center and Chugoku Cancer Center, National Hospital Organization, 3-1, Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan.
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2
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Restaino S, Scutiero G, Taliento C, Poli A, Bernardi G, Arcieri M, Santi E, Fanfani F, Chiantera V, Driul L, Scambia G, Greco P, Vizzielli G. Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis. Updates Surg 2023; 75:455-470. [PMID: 36811183 DOI: 10.1007/s13304-023-01465-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.
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Affiliation(s)
- S Restaino
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scutiero
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - Cristina Taliento
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy.
| | - A Poli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Bernardi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - M Arcieri
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122, Messina, Italy
| | - E Santi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - F Fanfani
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - V Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - L Driul
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - P Greco
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Paleekupt J, Sukhvibul P, Tansawet A, Kasetsermwiriya W, Laopeamthong I, Techapongsatorn S. A Quasi-Experimental Study Compared the Learning Experiences of Inexperienced Trainees Using Laparoscopic Surgery with 2-Dimensional and 3-Dimensional Imaging Systems. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s357311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Patel SK, Kashyrina O, Duru S, Miyabe M, Lim FY, Peiro JL, Stevenson CB. Comparison of two- and three-dimensional endoscopic visualization for fetal myelomeningocele repair: a pilot study using a fetoscopic surgical simulator. Childs Nerv Syst 2021; 37:1613-1621. [PMID: 33392653 DOI: 10.1007/s00381-020-04999-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the utility of three-dimensional (3D) versus conventional two-dimensional (2D) endoscopy for fetal myelomeningocele repair using a low-fidelity fetoscopic surgical simulator. METHODS A low-fidelity fetoscopic box trainer was developed for surgical simulation of myelomeningocele repair. Participants with varying surgical experience were recruited and completed three essential tasks (cutting skin, dural patch placement, and suturing skin) using both 2D and 3D endoscopic visualization. Participants were randomized to begin all tasks in either 2D or 3D. Time to completion was measured for each task, and each participant subsequently completed the NASA Load Index test and a questionnaire evaluating their experience. RESULTS Sixteen participants completed the study tasks using both 2D and 3D endoscopes in the simulator. While the mean performance time across all tasks was shorter with 3D versus 2D endoscopy (cutting skin, 47 vs. 54 seconds; dural patch placement, 38 vs. 52 seconds; and suturing skin, 424 vs. 499 seconds), the results did not reach statistical significance. When comparing times to completion of each of the three tasks between levels of expertise, participants in the expert category were faster when suturing skin on the 2D modality (P = 0.047). Under 3D visualization, experts were faster at cutting the skin (P = 0.008). When comparing experiences using the NASA-TLX test, participants felt that their performance was better using 3D over the 2D system (P = 0.045). Overall, 13 of 16 (81.3%) participants preferred 3D over 2D visualization. CONCLUSIONS Three-dimensional endoscopes could potentially be used in the near future for relative improvement in visualization and possibly performance during complex fetoscopic procedures such as prenatal repair of myelomeningocele defects. Further studies utilizing 3D scopes for other related procedures may potentially support clinical implementation of this technology in fetal surgery and also prove to be a useful tool in surgical training.
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Affiliation(s)
- Smruti K Patel
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2016, Cincinnati, OH, 45229-3039, USA
| | | | - Soner Duru
- Center for Fetal and Placental Research, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marcos Miyabe
- Center for Fetal and Placental Research, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Foong-Yen Lim
- Center for Fetal and Placental Research, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jose L Peiro
- Center for Fetal and Placental Research, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charles B Stevenson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2016, Cincinnati, OH, 45229-3039, USA. .,Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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5
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Tokas T, Avgeris M, Leotsakos I, Nagele U, Gözen AS. Impact of three-dimensional vision in laparoscopic partial nephrectomy for renal tumors. Turk J Urol 2020; 47:144-150. [PMID: 33337319 DOI: 10.5152/tud.2020.20439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare three-dimensional (3D) with standard two-dimensional (2D) laparoscopic partial nephrectomy (LPN) with respect to intra- and postoperative outcomes. MATERIAL AND METHODS Data from 112 patients who underwent transperitoneal LPN from 2012 to 2014 by a single experienced surgeon were collected. Sixty patients (group 1) underwent conventional 2D LPN and 52 patients (group 2) 3D LPN. Perioperative patient, procedure, and tumor data were recorded. The follow-up period was 1-5 years. RESULTS The two groups had similar patient age (p=0.834) and body mass index (p=0.141). The total laparoscopy time (LT) was shorter in group 2 (119.0 vs. 106.0 min; p=0.009). Warm ischemia times (WITs) were also shorter in group 2 (11.5 vs. 10.0 min; p=0.032). The estimated blood loss (EBL) (350.0 vs. 250.0 mL; p<0.001) and hemoglobin (Hb) decrease (1.55 vs. 1.35 g/dL; p=0.536) were lower in the 3D LPN group. Creatinine (0 vs. 0 g/dL; p=0.610) increase and estimated glomerular filtration rate (eGFR) decrease (0 vs. 0 mL/min/1.73 m2; p=0.553) did not demonstrate statistically significant differences. Duration of hospitalization (7 vs. 7 days; p=0.099) and complication rates (p=0.559) were similar between the two groups. CONCLUSION The new-generation 3D laparoscope has a great impact on significant LPN intraoperative parameters, mainly LT, WIT, and EBL. Hb decrease is also in favor of 3D vision, although not dramatically altered. Therefore, 3D LPN appears to be superior to conventional 2D LPNs.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
| | - Ioannis Leotsakos
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
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Sánchez-Margallo FM, Durán Rey D, Serrano Pascual Á, Mayol Martínez JA, Sánchez-Margallo JA. Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis. J Endourol 2020; 35:123-137. [PMID: 32799686 DOI: 10.1089/end.2020.0284] [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] [Indexed: 12/15/2022] Open
Abstract
Objective: The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. Methods: A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. Results: A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Conclusions: Three-dimensional laparoscopic systems essentially advance surgical performance in less-experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.
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Affiliation(s)
| | - David Durán Rey
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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7
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Abstract
Pyeloplasty is one of the most common urological reconstructive interventions. Since the presentation of the first open pyeloplasty by Anderson and Hynes in 1949, the management of ureteropelvic junction obstruction has dramatically developed. The most immense progress was made in the 1990s with the introduction of laparoscopy. A multitude of new minimal surgical techniques have been introduced since then. In the last few years, the innovations were based on refinement of already-existing techniques and technology. With this aim, single-port surgery, three-dimensional vision for laparoscopy, robotic technology, and alternative techniques for creating the anastomosis-like fibrin glue have been introduced. This unsystematic review is timely, and the scientific interest is to present and discuss some of the latest advances in surgical techniques and different approaches for the intra- and post-operative management in pyeloplasty. To the best of our knowledge, this is the only review looking at the recent advances in urological surgical techniques for pyeloplasty during the last few years with a focus on new technology and surgical techniques.
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Affiliation(s)
- Mikolaj Mendrek
- Departement of Urology, University Hospital Aachen, Aachen, 52074, Germany
| | | | - Christian Bach
- Departement of Urology, University Hospital Aachen, Aachen, 52074, Germany
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8
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Dewaele F, De Pauw T, Lumen N, Van Daele E, Hamerlynck T, Weyers S, Strubbe I, Van den Broeck F, Van Zele T, Van Roost D, Leybaert L, Kalmar AF, Van Nieuwenhove Y. Articulated Instruments and 3D Visualization: A Synergy? Evaluation of Execution Time, Errors, and Visual Fatigue. Surg Innov 2019; 26:456-463. [PMID: 30667302 DOI: 10.1177/1553350618822077] [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] [Indexed: 11/15/2022]
Abstract
Objective. The introduction of advanced endoscopic systems, such as the Storz Image1S and the Olympus Endoeye, heralds a new era of 3-dimensional (3D) visualization. The aim of this report is to provide a comprehensive overview of the neurophysiology of 3D view, its relevance in videoscopy, and to quantify the benefit of the new 3D technologies for both rigid and articulated instruments. Method. Sixteen medical students without any laparoscopic experience were trained each for a total of 27 hours. Proficiency scores were determined for rigid and articulated instruments under 2D and 3D visualization conditions. Results. A reduction in execution time of 14%, 28%, and 36% was seen for the rigid instruments, the da Vinci, and Steerable instruments, respectively. A reduction in errors of 84%, 92%, and 87% was seen for the rigid instruments, the da Vinci, and Steerable instruments, respectively. Conclusion. 3D visualization greatly augments endoscopic procedures. The advanced endoscopic systems employed in the recent study caused no visual fatigue or discomfort. The benefit of 3D was most distinct with articulated instruments.
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Affiliation(s)
- Frank Dewaele
- 1 Department of Neurosurgery, Ghent University Hospital, Belgium
| | - Tim De Pauw
- 1 Department of Neurosurgery, Ghent University Hospital, Belgium
| | | | - Elke Van Daele
- 3 Department of Gastrointestinal Surgery, Ghent University, Belgium
| | | | - Steven Weyers
- 4 Department of Gynaecology, Ghent University, Belgium
| | - Ine Strubbe
- 1 Department of Neurosurgery, Ghent University Hospital, Belgium
| | | | - Thibaut Van Zele
- 5 Department of Oto-rhino-laryngology, Ghent University, Belgium
| | - Dirk Van Roost
- 1 Department of Neurosurgery, Ghent University Hospital, Belgium
| | - Luc Leybaert
- 6 Department of Basic Medical Sciences, Ghent University, Belgium
| | - Alain F Kalmar
- 7 Department of Anesthesia and Critical Care Medicine, Maria Middelares Hospital, Ghent, Belgium
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9
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Nguyen DH, Nguyen BH, Van Nong H, Tran TH. Three-dimensional laparoscopy in urology: Initial experience after 100 cases. Asian J Surg 2019; 42:303-306. [DOI: 10.1016/j.asjsur.2018.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/11/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022] Open
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10
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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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11
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Abstract
As the frontiers of minimally invasive surgery (MIS) continue to expand, the availability and implementation of new technology in pediatric urology are increasing. MIS is already an integral part of pediatric urology, but there is still much more potential change to come as both recent and upcoming advances in laparoscopic and robotic surgery are surveyed.
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12
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Liu Q, Gao Y, Zhao Z, Zhao G, Liu R, Lau WY. Robotic resection of benign nonadrenal retroperitoneal tumors: A consecutive case series. Int J Surg 2018; 55:188-192. [DOI: 10.1016/j.ijsu.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/26/2018] [Accepted: 04/07/2018] [Indexed: 02/07/2023]
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13
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Schwab K, Smith R, Brown V, Whyte M, Jourdan I. Evolution of stereoscopic imaging in surgery and recent advances. World J Gastrointest Endosc 2017; 9:368-377. [PMID: 28874957 PMCID: PMC5565502 DOI: 10.4253/wjge.v9.i8.368] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
In the late 1980s the first laparoscopic cholecystectomies were performed prompting a sudden rise in technological innovations as the benefits and feasibility of minimal access surgery became recognised. Monocular laparoscopes provided only two-dimensional (2D) viewing with reduced depth perception and contributed to an extended learning curve. Attention turned to producing a usable three-dimensional (3D) endoscopic view for surgeons; utilising different technologies for image capture and image projection. These evolving visual systems have been assessed in various research environments with conflicting outcomes of success and usability, and no overall consensus to their benefit. This review article aims to provide an explanation of the different types of technologies, summarise the published literature evaluating 3D vs 2D laparoscopy, to explain the conflicting outcomes, and discuss the current consensus view.
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14
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Liu R, Liu Q, Zhao ZM, Tan XL, Gao YX, Zhao GD. Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study. J Surg Oncol 2017. [PMID: 28628713 DOI: 10.1002/jso.24676] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic distal pancreatectomy (RDP) is considered a safe and feasible alternative to laparoscopic distal pancreatectomy (LDP). However, previous studies have some limitations including small sample size and selection bias. This study aimed to evaluate whether the robotic approach has advantages over laparoscopic surgery in distal pancreatectomy. METHODS Demographics and perioperative outcomes among patients undergoing RDP (n = 102) and LDP (n = 102) between January 2011 and December 2015 were reviewed. A 1:1 propensity score matched analysis was performed between both groups. RESULTS Both groups displayed no significant differences in perioperative outcomes including operative time, blood loss, transfusion rate, and rates of overall morbidities and pancreatic fistula. Robotic approach reduced the rate of conversion to laparotomy (2.9% vs 9.8%, P = 0.045), especially in patients with large tumors (0% vs 22.2%, P = 0.042). RDP improved spleen (SP) and splenic vessels preservation (SVP) rates in patients with moderate tumors (60.0% vs 35.5%, P = 0.047; 37.1% vs 12.9%, P = 0.025), especially in patients without malignancy (95.5% vs 52.4%, P = 0.001; 59.1% vs 19.0%, P = 0.007). RDP also reduced postoperative hospital stay (PHS) significantly (7.67% vs 8.58, P = 0.032). CONCLUSIONS RDP is associated with less rate of conversion to laparotomy, shorter PHS, and improved SP and SVP rates in selected patients than LDP.
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Affiliation(s)
- Rong Liu
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qu Liu
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of General Surgery, Tianjin, China
| | - Zhi-Ming Zhao
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiang-Long Tan
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuan-Xing Gao
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Guo-Dong Zhao
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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15
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Pentafecta Rates of Three-Dimensional Laparoscopic Radical Prostatectomy: Our Experience after 150 Cases. Urologia 2017; 84:93-97. [DOI: 10.5301/uj.5000239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/27/2023]
Abstract
Introduction Three-dimensional (3D) laparoscopy with a flexible camera was developed to overcome the main limitation of traditional laparoscopic surgery, which is two-dimensional (2D) vision. The aim of our article is to present the largest casistic of 3D laparoscopic radical prostatectomy (LRP) available in literature and evaluate our results in terms of pentafecta and compare it with the literature. Methods We retrospectively evaluated consecutive patients who underwent LRP with 3D technology between March 2014 and December 2015. Total operative time (TOT), anasthomosis time (AT), blood loss and complications were registered. All patients presented at least 3 months of follow-up. Surgical outcome was evaluated in terms of Pentafecta. Results One hundred fifty consecutive patients underwent 3D LRP. Mean follow-up was 16.9 months. Mean age was 67.7 ± 8.3 years (range 50-76). Mean preoperative PSA value was 8.3 ± 5.8 ng/ml and mean bioptic Gleason Score (GS) was 6.6. We had a mean TOT of 158 ± 23 minutes and a mean AT of 25 ± 12.6. Mean blood loss was 240 ± 40 ml. Eighteen (12%) postoperative complications occurred. Pathologic results: pT2 in 91 patients (58%) and pT3 in 59 (39.3%). Pentafecta was reached by 31.3% of patients at 3 months and 51.6% at 12 months. Conclusions Our oncological and functional results are comparable to those present in literature for laparoscopic and robotic surgery. We believe that our findings can encourage the use of 3D laparoscopy especially considering the increasing attention to healthcare costs.
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Lara-Domínguez MD, López-Jiménez A, Grabowski JP, Arjona-Berral JE, Zapardiel I. Prospective observational study comparing traditional laparoscopy and three-dimensional laparoscopy in gynecologic surgery. Int J Gynaecol Obstet 2017; 136:320-324. [DOI: 10.1002/ijgo.12078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/24/2016] [Accepted: 12/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Jacek P. Grabowski
- Department of Gynecology; European Competence Center for Ovarian Cancer; Charité-University Medicine of Berlin; Berlin Germany
| | | | - Ignacio Zapardiel
- Gynecologic Oncology Unit; La Paz University Hospital; IdiPAZ; Madrid Spain
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Fergo C, Burcharth J, Pommergaard HC, Kildebro N, Rosenberg J. Three-dimensional laparoscopy vs 2-dimensional laparoscopy with high-definition technology for abdominal surgery: a systematic review. Am J Surg 2017; 213:159-170. [DOI: 10.1016/j.amjsurg.2016.07.030] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 06/19/2016] [Accepted: 07/06/2016] [Indexed: 12/30/2022]
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Impact of Training on Three-Dimensional versus Two-Dimensional Laparoscopic Systems on Acquisition of Laparoscopic Skills in Novices: A Prospective Comparative Pilot Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4197693. [PMID: 27995141 PMCID: PMC5138442 DOI: 10.1155/2016/4197693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/14/2016] [Accepted: 10/26/2016] [Indexed: 01/23/2023]
Abstract
In this prospective educational study, 10 medical students (novices) were randomized to practice two basic laparoscopic tasks from the MISTELS program, namely, Pegboard Transfer (PT) and Intracorporeal Knot Tying (IKT) tasks, using either a 2D or a 3D laparoscopic platform. There was no significant difference between both groups in the baseline assessments (PT task: 130.8 ± 18.7 versus 151.5 ± 33.4; p = 0.35) (IKT task: 123.9 ± 41.0 versus 122.9 ± 44.9; p = 0.986). Following two training sessions, there was a significant increase in the scores of PT task for the 2D (130.8 ± 18.7 versus 222.6 ± 7.0; p = 0.0004) and the 3D groups (151.5 ± 33.4 versus 211.7 ± 16.2; p = 0.0001). Similarly, there was a significant increase in the scores of IKT task for the 2D (123.9 ± 41.0 versus 373.3 ± 47.2; p = 0.003) and the 3D groups (122.9 ± 44.9 versus 338.8 ± 28.6; p = 0.0005). However, there was no significant difference in the final assessment scores between 2D and 3D groups for both tasks (p > 0.05). Therefore, 3D laparoscopic systems do not provide an advantage over 2D systems for training novices in basic laparoscopic skills.
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DeLucia PR, Hoskins ML, Griswold JA. Laparoscopic Surgery: Are Multiple Viewing Perspectives Better than one? ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193120404801507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Imaging systems are used increasingly in surgical procedures such as laparoscopy. Depth perception is degraded compared with open surgery because the image provided by a laparoscopic camera is two-dimensional and represents a single viewing perspective. One way to compensate for this loss of depth information is with multiple cameras, each providing a different perspective. We measured performance of a pick-and-place task when observers viewed the task environment with three cameras concurrently (top, front, side views) or with one camera. Performance was slower with camera viewing compared with direct viewing and slowest with the side view. Although concurrent presentation of three camera views did not improve performance, observers looked almost exclusively at one of these views (top). Future research should determine whether observers can be trained to use depth information provided by multiple cameras. It is important to determine how to configure imaging systems so that surgical procedures can be optimized.
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Affiliation(s)
- Patricia R. DeLucia
- Texas Tech University, Texas Tech University Health Sciences Center Lubbock, Texas
| | - Melody L. Hoskins
- Texas Tech University, Texas Tech University Health Sciences Center Lubbock, Texas
| | - John A. Griswold
- Texas Tech University, Texas Tech University Health Sciences Center Lubbock, Texas
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Abstract
In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy.
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Dong S, Yang XN, Zhong WZ, Nie Q, Liao RQ, Lin JT, Wu YL. Comparison of three-dimensional and two-dimensional visualization in video-assisted thoracoscopic lobectomy. Thorac Cancer 2016; 7:530-534. [PMID: 27766782 PMCID: PMC5130219 DOI: 10.1111/1759-7714.12361] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/05/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) lobectomy has emerged as a safe and effective technique for treating early-stage lung cancer. Novel three-dimensional, high-definition (3D HD) imaging has removed this technical obstacle and is increasingly used in laparoscopic surgery. We compared our initial experience of 3D HD VATS with standard two-dimensional (2D) HD VATS to identify the advantages and disadvantages of 3D HD visualization in VATS. METHODS The data of consecutive patients diagnosed with lung cancer who underwent 2D or 3D thoracoscopic lobectomy or bilobectomy at the Guangdong Lung Cancer Institute from July 2013 to October 2014 were retrospectively analyzed. Operation duration, estimated blood loss, length of postoperative stay, major complications, and mortality were recorded for each patient. RESULTS In total, 359 patients were enrolled in the study. Lobectomy was performed in 339 patients and bilobectomy in 20; the 3D HD system was used for 178 of the 359 patients, and the 2D HD system for 181. Tumor size, distribution of the resected lobes, and the demographic characteristics of the patients were matched between the two groups. The mean operative time for 3D VATS was 163 minutes (range 60-330), whereas 2D VATS required 184 minutes (range 75-360; P < 0.001). The volume of blood loss was 109 and 144 mL in the 3D and 2D VATS groups, respectively (P = 0.064). CONCLUSIONS The new-generation 3D HD imaging system is feasible and safe for thoracic lobectomy. The 3D system required a shorter operative duration.
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Affiliation(s)
- Song Dong
- Division of Surgery, Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong, China
| | - Xue-Ning Yang
- Division of Surgery, Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong, China
| | - Wen-Zhao Zhong
- Division of Surgery, Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong, China
| | - Qiang Nie
- Division of Surgery, Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong, China
| | - Ri-Qiang Liao
- Division of Surgery, Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong, China
| | - Jun-Tao Lin
- Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Division of Surgery, Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong, China.,Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
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The Conflicting Evidence of Three-dimensional Displays in Laparoscopy: A Review of Systems Old and New. Ann Surg 2016; 263:234-9. [PMID: 26501704 DOI: 10.1097/sla.0000000000001504] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe studies evaluating 3 generations of three-dimensional (3D) displays over the course of 20 years. SUMMARY BACKGROUND DATA Most previous studies have analyzed performance differences during 3D and two-dimensional (2D) laparoscopy without using appropriate controls that equated conditions in all respects except for 3D or 2D viewing. METHODS Databases search consisted of MEDLINE and PubMed. The reference lists for all relevant articles were also reviewed for additional articles. The search strategy employed the use of keywords "3D," "Laparoscopic," "Laparoscopy," "Performance," "Education," "Learning," and "Surgery" in appropriate combinations. RESULTS Our current understanding of the performance metrics between 3D and 2D laparoscopy is mostly from the research with flawed study designs. This review has been written in a qualitative style to explain in detail how prior research has underestimated the potential benefit of 3D displays and the improvements that must be made in future experiments comparing 3D and 2D displays to better determine any advantage of using one display or the other. CONCLUSIONS Individual laparoscopic performance in 3D may be affected by a multitude of factors. It is crucial for studies to measure participant stereoscopic ability, control for system crosstalk, and use validated measures of performance.
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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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Kyriazis I, Özsoy M, Kallidonis P, Vasilas M, Panagopoulos V, Liatsikos E. Integrating Three-Dimensional Vision in Laparoscopy: The Learning Curve of an Expert. J Endourol 2015; 29:657-60. [DOI: 10.1089/end.2014.0766] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | - Mehmet Özsoy
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Gómez-Gómez E, Carrasco-Valiente J, Valero-Rosa J, Campos-Hernández J, Anglada-Curado F, Carazo-Carazo J, Font-Ugalde P, Requena-Tapia M. Impact of 3D vision on mental workload and laparoscopic performance in inexperienced subjects. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2015.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gómez-Gómez E, Carrasco-Valiente J, Valero-Rosa J, Campos-Hernández J, Anglada-Curado F, Carazo-Carazo J, Font-Ugalde P, Requena-Tapia M. Impact of 3D vision on mental workload and laparoscopic performance in inexperienced subjects. Actas Urol Esp 2015; 39:229-35. [PMID: 25457567 DOI: 10.1016/j.acuro.2014.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the effect of vision in three dimensions (3D) versus two dimensions (2D) on mental workload and laparoscopic performance during simulation-based training. MATERIALS AND METHODS A prospective, randomized crossover study on inexperienced students in operative laparoscopy was conducted. Forty-six candidates executed five standardized exercises on a pelvitrainer with both vision systems (3D and 2D). Laparoscopy performance was assessed using the total time (in seconds) and the number of failed attempts. For workload assessment, the validated NASA-TLX questionnaire was administered. RESULTS 3D vision improves the performance reducing the time (3D = 1006.08 ± 315.94 vs. 2D = 1309.17 ± 300.28; P < .001) and the total number of failed attempts (3D = .84 ± 1.26 vs. 2D = 1.86 ± 1.60; P < .001). For each exercise, 3D vision also shows better performance times: "transfer objects" (P = .001), "single knot" (P < .001), "clip and cut" (P < .05), and "needle guidance" (P < .001). Besides, according to the NASA-TLX results, less mental workload is experienced with the use of 3D (P < .001). However, 3D vision was associated with greater visual impairment (P < .01) and headaches (P < .05). CONCLUSION The incorporation of 3D systems in laparoscopic training programs would facilitate the acquisition of laparoscopic skills, because they reduce mental workload and improve the performance on inexperienced surgeons. However, some undesirable effects such as visual discomfort or headache are identified initially.
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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: 178] [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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Novice surgeons: do they benefit from 3D laparoscopy? Lasers Med Sci 2015; 30:1325-33. [DOI: 10.1007/s10103-015-1739-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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Bagan P, De Dominicis F, Hernigou J, Dakhil B, Zaimi R, Pricopi C, Le Pimpec Barthes F, Berna P. Complete thoracoscopic lobectomy for cancer: comparative study of three-dimensional high-definition with two-dimensional high-definition video systems. Interact Cardiovasc Thorac Surg 2015; 20:820-3. [DOI: 10.1093/icvts/ivv031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/04/2015] [Indexed: 01/17/2023] Open
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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: 3.9] [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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Zdichavsky M, Schmidt A, Luithle T, Manncke S, Fuchs J. Three-dimensional laparoscopy and thoracoscopy in children and adults: A prospective clinical trial. MINIM INVASIV THER 2014; 24:154-60. [DOI: 10.3109/13645706.2014.968171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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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: 3.0] [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: 1.1] [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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Aykan S, Singhal P, Nguyen DP, Yigit A, Tuken M, Yakut E, Colakerol A, Sulejman S, Semercioz A. Perioperative, Pathologic, and Early Continence Outcomes Comparing Three-Dimensional and Two-Dimensional Display Systems for Laparoscopic Radical Prostatectomy—A Retrospective, Single-Surgeon Study. J Endourol 2014; 28:539-43. [DOI: 10.1089/end.2013.0630] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Serdar Aykan
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Paras Singhal
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Daniel P. Nguyen
- Department of Urology, Berne University Hospital, Berne, Switzerland
| | - Akin Yigit
- Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey
| | - Murat Tuken
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Emrah Yakut
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Suhejb Sulejman
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Lusch A, Bucur PL, Menhadji AD, Okhunov Z, Liss MA, Perez-Lanzac A, McDougall EM, Landman J. Evaluation of the impact of three-dimensional vision on laparoscopic performance. J Endourol 2014; 28:261-6. [PMID: 24059674 DOI: 10.1089/end.2013.0344] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Recent technological advancements have led to the introduction of new three-dimensional (3D) cameras in laparoscopic surgery. The 3D view has been touted as useful during robotic surgery, however, there has been limited investigation into the utility of 3D in laparoscopy. MATERIALS AND METHODS We performed a prospective, randomized crossover trial comparing a 0° 3D camera with a conventional 0° two-dimensional (2D) camera using a high definition monitor (Karl Storz, Tuttlingen, Germany). All participants completed six standardized basic skills tasks. Quality testing scores were measured by the number of drops, grasping attempts, and precision of needle entry and exiting. Additionally, resolution, color distribution, depth of field and distortion were measured using optical test targets. RESULTS In this pilot study, we evaluated 10 medical students, 7 residents, and 7 expert surgeons. There was a significant difference in the performance in all the six skill tasks, for the three levels of surgical expertise and training levels in 2D vs 3D except for the cut the line quality score and the peg transfer quality score. Adjusting for the training level, 3D camera image results were superior for the number of rings left (p=0.041), ring transfer quality score (p=0.046), thread the rings (no. of rings) (p=0.0004), and thread the rings quality score (p=0.0002). The 3D camera image was also superior for knot tying (quality score) (p=0.004), peg transfer (time in seconds) (p=0.047), peg transfer pegs left (p=0.012), and for peg transfer quality score (p=0.001). The 3D camera system showed significantly less distortion (p=0.0008), a higher depth of field (p=0.0004) compared with the 2D camera system. CONCLUSION 3D laparoscopic camera equipment results in a significant improvement in depth perception, spatial location, and precision of surgical performance compared with the conventional 2D camera equipment. With this improved quality of vision, even expert laparoscopic surgeons may benefit from 3D imaging.
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Affiliation(s)
- Achim Lusch
- Department of Urology, University of California , Irvine, Orange, California
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Cicione A, Autorino R, Breda A, De Sio M, Damiano R, Fusco F, Greco F, Carvalho-Dias E, Mota P, Nogueira C, Pinho P, Mirone V, Correia-Pinto J, Rassweiler J, Lima E. Three-dimensional vs standard laparoscopy: comparative assessment using a validated program for laparoscopic urologic skills. Urology 2013; 82:1444-50. [PMID: 24094658 DOI: 10.1016/j.urology.2013.07.047] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/09/2013] [Accepted: 07/18/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare the last generation of 3-dimensional imaging (3D) vs standard 2-dimensional imaging (2D) laparoscopy. MATERIALS AND METHODS A prospective observational study was conducted during the 4th Minimally Invasive Urological Surgical Week Course held in Braga (Portugal) in April 2013. The course participants and faculty were asked to perform standardized tasks in the dry laboratory setting and randomly assigned into 2 study groups; one starting with 3D, the other with 2D laparoscopy. The 5 tasks of the European Training in Basic Laparoscopic Urological Skills were performed. Time to complete each task and errors made were recorded and analyzed. An end-of-study questionnaire was filled by the participants. RESULTS Ten laparoscopic experts and 23 laparoscopy-naïve residents were included. Overall, a significantly better performance was obtained using 3D in terms of time (1115 seconds, interquartile range [IQR] 596-1469 vs 1299 seconds, IQR 620-1723; P = .027) and number of errors (2, IQR 1-3 vs 3, IQR 2-5.5; P = .001). However, the experts were faster only in the "peg transfer" task when using the 3D, whereas naïves improved their performance in 3 of the 5 tasks. A linear correlation between level of experience and performance was found. Three-dimensional imaging was perceived as "easier" by a third of the laparoscopy-naïve participants (P = .027). CONCLUSION Three-dimensional imaging seems to facilitate surgical performance of urologic surgeons without laparoscopic background in the dry laboratory setting. The advantage provided by 3D for those with previous laparoscopic experience remains to be demonstrated. Further studies are needed to determine the actual advantage of 3D over standard 2D laparoscopy in the clinical setting.
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Affiliation(s)
- Antonio Cicione
- Life and Health Sciences Research Institute, Universidade do Minho, Braga, Portugal; Urology Unit, Magna Graecia University, Catanzaro, Italy
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Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 2013; 257:128-32. [PMID: 22868357 DOI: 10.1097/sla.0b013e31825fff08] [Citation(s) in RCA: 222] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay, and recovery as compared with open distal pancreatectomy. Technical limitations of laparoscopic surgery may limit patient eligibility and require conversion to open or hand-assisted surgery to maintain patient safety. We hypothesized that robot-assisted distal pancreatectomy (RADP) was superior to LDP as a result of improved surgical manipulation and visualization, potentially expanding the indications for minimally invasive pancreatectomy. METHODS We performed a retrospective analysis of all minimally invasive distal pancreatectomies at University of Pittsburgh Medical Center between January 2004 and February 2011. We compared the perioperative outcomes, 90-day morbidity and mortality of our first 30 RADPs to 94 consecutive historical control LDPs. RESULTS Patients undergoing RADP and LDP demonstrated equivalent age, sex, race, American Society of Anesthesiologists' score, and tumor size. Postoperative length of hospital stay and rates of pancreatic fistula, blood transfusion, and readmission were not statistically different. Patients in the RADP group did not require conversion to open surgery unlike the LDP group (16%, P < 0.05) and had reduced risk of excessive blood loss. There were more pancreatic ductal adenocarcinomas approached robotically (43%) than laparoscopically (15%) (P < 0.05). Oncological outcomes in these cases were superior for the robotic-assisted group with higher rates of margin negative resection and improved lymph node yield for both benign and malignant lesions (P < 0.0001). CONCLUSIONS RADPs were equivalent to LDPs in nearly all measures of outcome and safety but significantly reduced the risk of conversion to open resection, despite a statistically greater probability of malignancy in the robotic cohort. We concluded that robotic assistance may broaden indications for minimally invasive pancreatectomy.
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Affiliation(s)
- Mustapha Daouadi
- Division of GI Surgical Oncology, General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
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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: 104] [Impact Index Per Article: 8.0] [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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Wang Z, Zheng Q, Jin Z. Meta-analysis of robot-assisted versus conventional laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. ANZ J Surg 2012; 82:112-7. [PMID: 22510118 DOI: 10.1111/j.1445-2197.2011.05964.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Conventional laparoscopic Nissen fundoplication (CLF) is generally considered the surgical approach of choice for gastro-oesophageal reflux disease. Robotic-assisted laparoscopic fundoplication (RALF) has recently been introduced into laparoscopic clinical practice with the aim of improving surgical performance by eliminating tremors and fatigue. A meta-analysis of randomized clinical trials (RCTs) was performed to compare RALF and CLF. METHODS Medline, Embase, ISI Web of Knowledge CPCI-S and The Cochrane Library were searched and the methodological quality of included trials was evaluated. Outcomes evaluated were intraoperative, dysphagia, flatulence, antisecretory medication, satisfaction with intervention, operation time, hospital stay and total cost. Results were pooled in meta-analyses as risk ratios and weighted mean differences (WMD). RESULTS Of 221 patients in six RCTs, 111 were allocated to CLF and 110 to RALF. RALF prolonged total time necessary to carry out fundoplication (WMD 3.17 (95% confidence interval. 2.33-4.00) min; P < 0.00001, χ(2) P = 0.25, I(2) = 24%). Operation complication, antisecretory medication, satisfaction with intervention, the time needed for hiatal dissection, the time from incision to completion of sutures, the total operation time and total cost were similar in both groups. CONCLUSION Clinical outcomes from RALF were comparable to CLF approach, but RALF prolonged the operation time. Currently, CLF should be routinely used as costs are lower.
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Affiliation(s)
- Zhanhui Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, China
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A guide to stereoscopic 3D displays in medicine. Acad Radiol 2011; 18:1035-48. [PMID: 21652229 DOI: 10.1016/j.acra.2011.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/08/2011] [Accepted: 04/22/2011] [Indexed: 01/21/2023]
Abstract
Stereoscopic displays can potentially improve many aspects of medicine. However, weighing the advantages and disadvantages of such displays remains difficult, and more insight is needed to evaluate whether stereoscopic displays are worth adopting. In this article, we begin with a review of monocular and binocular depth cues. We then apply this knowledge to examine how stereoscopic displays can potentially benefit diagnostic imaging, medical training, and surgery. It is apparent that the binocular depth information afforded by stereo displays 1) aid the detection of diagnostically relevant shapes, orientations, and positions of anatomical features, especially when monocular cues are absent or unreliable; 2) help novice surgeons orient themselves in the surgical landscape and perform complicated tasks; and 3) improve the three-dimensional anatomical understanding of students with low visual-spatial skills. The drawbacks of stereo displays are also discussed, including extra eyewear, potential three-dimensional misperceptions, and the hurdle of overcoming familiarity with existing techniques. Finally, we list suggested guidelines for the optimal use of stereo displays. We provide a concise guide for medical practitioners who want to assess the potential benefits of stereo displays before adopting them.
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Rassweiler J, Hruza M, Klein J, Goezen AS, Teber D. The Role of Laparoscopic Radical Prostatectomy in the Era of Robotic Surgery. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eursup.2010.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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: 73] [Impact Index Per Article: 4.6] [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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Tabaee A, Anand VK, Fraser JF, Brown SM, Singh A, Schwartz TH. Three-dimensional endoscopic pituitary surgery. Neurosurgery 2009; 64:288-93; discussion 294-5. [PMID: 19404107 DOI: 10.1227/01.neu.0000338069.51023.3c] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We describe a novel 3-dimensional (3-D) stereoendoscope and discuss our early experience using it to provide improved depth perception during transsphenoidal pituitary surgery. METHODS Thirteen patients underwent endonasal endoscopic transsphenoidal surgery. A 6.5-, 4.9-, or 4.0-mm, 0- and 30-degree rigid 3-D stereoendoscope (Visionsense, Ltd., Petach Tikva, Israel) was used in all cases. The endoscope is based on "compound eye" technology, incorporating a microarray of lenses. Patients were followed prospectively and compared with a matched group of patients who underwent endoscopic surgery with a 2-dimensional (2-D) endoscope. Surgeon comfort and/or complaints regarding the endoscope were recorded. RESULTS The 3-D endoscope was used as the sole method of visualization to remove 10 pituitary adenomas, 1 cystic xanthogranuloma, 1 metastasis, and 1 cavernous sinus hemangioma. Improved depth perception without eye strain or headache was noted by the surgeons. There were no intraoperative complications. All patients without cavernous sinus extension (7of 9 patients) had gross tumor removal. There were no significant differences in operative time, length of stay, or extent of resection compared with cases in which a 2-D endoscope was used. Subjective depth perception was improved compared with standard 2-D scopes. CONCLUSION In this first reported series of purely 3-D endoscopic transsphenoidal pituitary surgery, we demonstrate subjectively improved depth perception and excellent outcomes with no increase in operative time. Three-dimensional endoscopes may become the standard tool for minimal access neurosurgery.
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Affiliation(s)
- Abtin Tabaee
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10065, USA
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The impact of inherent and environmental factors on surgical performance in laparoscopy: a review. MINIM INVASIV THER 2009; 12:69-75. [PMID: 16754081 DOI: 10.1080/13645700310013204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Training and experience amongst laparoscopic surgeons remain varied. The demands associated with this form of surgery are thought to be greater than those for traditional open surgery. This article examines the surgeon-specific and environmental factors that contribute to performance in laparoscopic surgery.
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Rassweiler J, Safi KC, Subotic S, Teber D, Frede T. Robotics and telesurgery – an update on their position in laparoscopic radical prostatectomy. MINIM INVASIV THER 2009; 14:109-22. [PMID: 16754625 DOI: 10.1080/13645700510010908] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date, more than 3000 laparoscopic radical prostatectomies have been performed worldwide at 92 centres with this system. The main advantage of the system represents the translation of open surgical skills to laparoscopy. Despite recent development of basic tools (e.g. bipolar forceps) for the da Vinci robot, investment and maintenance costs still represent the major problem of the device. Additionally, the device does not provide any haptic sense (i.e. tactile feedback). Robotic surgery represents a turning point of surgical research. However, broad use of robotic systems is limited mainly because of the high investment and running costs. Interestingly, more than in the field of cardiac surgery, there seems to be a need for telemanipulators in urology, mainly to reduce the learning curve of standard laparoscopy. However, new training concepts used in combination with mono-tasking computerized robots (AESOP) have proved their efficacy associated with a significant cost reduction.
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Affiliation(s)
- J Rassweiler
- Department of Urology, Klinikum Heilbronn, University of Heidelberg, Germany.
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Igarashi T, Suzuki H, Naya Y. Computer-based endoscopic image-processing technology for endourology and laparoscopic surgery. Int J Urol 2009; 16:533-43. [DOI: 10.1111/j.1442-2042.2009.02258.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
BACKGROUND Simulators are being used to teach laparoscopic skills before residents get to the operating room. It is unknown whether the use of three-dimensional (3D) vision will facilitate laparoscopic training. Therefore, our objective was to compare the effectiveness of using 3D imaging over the traditional two-dimensional (2D) imaging to teach laparoscopic simulator skills to novice individuals and assess whether 3D imaging ameliorates laparoscopic performance for surgeons who have already adapted to working within a 2D surgical environment. METHODS This prospective study involved 36 surgical residents and students. Inexperienced participants included medical students and first- and second-year surgical residents (n = 25). Experienced participants included third- and fifth-year surgical residents (n = 11). Participants were tested on six laparoscopic skills using 2D or 3D imaging systems and then retested about 3 months later using the opposing imaging system. Evaluation of performance was based on the time elapsed to task completion and the errors committed during that time. RESULTS The experienced participants performed better than the inexperienced participants regardless of the imaging system. Inexperienced participants initially tested using 2D imaging required significantly more time and/or made more errors to complete five of the six laparoscopic tasks compared to those initially tested using 3D imaging (p < 0.05). After initial testing on 3D imaging, inexperienced participants retested using 2D imaging performed significantly better on five of six tasks compared to the scores of inexperienced participants initially tested on 2D imaging (p < 0.05). In contrast, the inexperienced participants' retested on 3D after initial 2D imaging did not improve on any laparoscopic task compared to the scores of inexperienced participants initially tested on 3D imaging. Among the experienced participants, no significant difference in time or errors to task completion was observed under 2D imaging compared to 3D imaging during the first or second testing session. CONCLUSIONS Our study indicates that 3D imaging offers significant advantages in the teaching of laparoscopic skills to inexperienced individuals.
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Mamelak AN, Danielpour M, Black KL, Hagike M, Berci G. A High-Definition Exoscope System for Neurosurgery and Other Microsurgical Disciplines: Preliminary Report. Surg Innov 2008; 15:38-46. [PMID: 18388000 DOI: 10.1177/1553350608315954] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An 8-mm diameter rigid lens telescope with a focal distance of 20 cm was developed for open microsurgery. The telescope was attached to a 3-chip high-definition digital camera and then to a high-definition monitor. A pneumatic scope holder permitted repositioning. The optical quality of the device was compared with the operating microscope with a step wedge and 1-mm grid paper. Craniotomies and microsurgical dissections with the telescope system (high-definition exoscope system) were performed in a live pig model. The high-definition exoscope system provided image quality that rivaled the operating microscope even at high magnification. The system was easy to manipulate and comfortable during neurosurgical operations. The lack of stereopsis was a relative drawback of the system but was compensated for with repeated procedures. Overall, this prototype telescope-based system rivals the operating microscope optical quality and field of view. With further refinement, this system could have widespread application in many microsurgical disciplines.
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Affiliation(s)
- Adam N. Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center Los Angeles, California, , Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Moise Danielpour
- Department of Neurosurgery, Cedars-Sinai Medical Center Los Angeles, California, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Keith L. Black
- Department of Neurosurgery, Cedars-Sinai Medical Center Los Angeles, California, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Masanobu Hagike
- Department of Neurosurgery, Cedars-Sinai Medical Center Los Angeles, California, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - George Berci
- Department of Neurosurgery, Cedars-Sinai Medical Center Los Angeles, California, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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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: 48] [Impact Index Per Article: 2.7] [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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Berci G, Phillips E. High-definition television: why we have to pass the electronic Surgical Education and Self-Assessment Program (SESAP) test. Surg Endosc 2007; 21:1261-3. [PMID: 17619928 DOI: 10.1007/s00464-007-9471-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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