Abstract
Laparoscopic gastrectomy for gastric cancer is now widely accepted and has become a standard surgery. This study investigated the advantages of three-dimensional (3D) stereoscopic visualization for laparoscopic gastrectomy over a conventional two-dimensional (2D) planar screen. The primary outcome of this study was operative time. Ninety-four consecutive cases of gastric cancer patients who underwent laparoscopic total gastrectomy (LTG) (25 cases) or laparoscopic distal gastrectomy (LDG) (69 cases) were enrolled in this study before and after the introduction of the 3D system. Operative time was significantly shorter in the 3D groups for both LTG (351 vs. 406 min, P = 0.026) and LDG (269 vs. 344 min, P < 0.01). During intracorporeal procedures, dissection time was significantly shorter in the 3D groups for both LTG (183 vs. 232 min, P = 0.011) and LDG (161 vs. 213 min, P < 0.01), although the time needed for anastomosis was similar between the groups. However, operators preferred intracorporeal knot-tying as a ligature for anastomosis under 3D (LTG, P = 0.012; LDG, P < 0.01). These data suggest that 3D stereoscopic visualization shortens the operative time of laparoscopic gastrectomy by reducing the intracorporeal dissection time.
Highlights
Recent advances in surgical devices are outstanding with new, innovative designs available almost every year
We performed multivariate analyses with factors that showed associations with P values < 0.2 in the univariate analysis, with similar results. These analyses showed that the type of visualization (3D/2D) correlated with operative time for both laparoscopic total gastrectomy (LTG) and laparoscopic distal gastrectomy (LDG), and that 3D stereoscopic visualization corresponded to significantly shorter operative time
The postoperative hospital stay of the 3D patients was significantly shorter in both LTG (P < 0.01) and LDG (P = 0.035). This is the first study to show a direct benefit of 3D stereoscopic visualization over 2D for laparoscopic gastrectomy with advanced lymphadenectomy and intracorporeal anastomosis
Summary
Recent advances in surgical devices are outstanding with new, innovative designs available almost every year. In addition to the benefit of dry box training, there are some reports showing the clinical benefit of 3D displays during laparoscopic/thoracoscopic surgeries in urology, gynaecology, thoracic and rectal surgery. As for laparoscopic gastric surgery, there were no previous studies showing the direct benefit of 3D stereoscopic visualization to reduce total operative time, some have shown only a limited 3D benefit. A detailed study was necessary to draw conclusions about the possible benefit of 3D stereoscopic visualization for laparoscopic gastrectomy for gastric cancer. We report that 3D stereoscopic visualization shortened total operative time for both laparoscopic total gastrectomies (LTG) and laparoscopic distal gastrectomies (LDG) for gastric cancer. Www.nature.com/scientificreports performed under 3D was significantly shorter than under 2D. Our data demonstrates the benefit of 3D stereoscopic visualization during laparoscopic gastrectomy for gastric cancer by confirming shorter operative times
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