Three-Dimensional Versus Two-Dimensional Laparoscopic-Assisted Transanal Pull-Through for Hirschsprung's Disease in Children: Preliminary Results of a Prospective Cohort Study in a Tertiary Hospital.

Abstract

This prospective cohort study is aimed to compare the efficacy and safety of three-dimensional (3D) versus two-dimensional (2D) laparoscopy in laparoscopic-assisted transanal pull-through (LATP) for the surgical treatment of Hirschsprung's disease (HD) in children. This study enrolled 80 children who were histologically diagnosed with HD and undergone LATP performed by a single experienced surgeon at our department between January 2015 and November 2017. Children were randomized to receive 2D laparoscopy (n = 40) or 3D laparoscopy (n = 40). Data on patient characteristics, operative parameters, and the surgeon's assessment on utilization of laparoscopic system were prospectively recorded and analyzed. Patient characteristics, including age at surgery, gender, weight, and the level of aganglionosis, were comparable between the two groups (each P > .05). Compared with 2D imaging system, 3D system significantly shortened the performance time of laparoscopic phase (27.0 ± 3.6 minutes versus 38.3 ± 4.3 minutes, P < .001) with a 29.5% reduction, and the total time of the entire surgery (106.0 ± 19.5 minutes versus 122.1 ± 18.7 minutes, P < .001). No statistical difference was observed in terms of estimated intraoperative blood loss and intraoperative laparoscopic complications between the two groups (each P > .05). In addition, 3D system significantly improved depth perception and precision, and reduced surgical strain for the surgeon. 3D LATP is feasible and safe in the surgical treatment of HD in children. Further studies are still needed to investigate the application of 3D in both experienced and inexperienced surgeons.