3D Laparoscopy Research Articles

3D vs. 2D-4 K: Performance and self-perception of laparoscopic novices in a randomized prospective teaching intervention using standard tasks and box trainers

ObjectiveThe use of three-dimensional (3D) laparoscopy in surgical practice and training has been an area of research and discussion. Studies have suggested that 3D vision can improve speed and precision compared to traditional two-dimensional (2D) displays, while other authors found no benefits on the learning curves of laparoscopic novices. Modern two-dimensional laparoscopy with a resolution of 3840 × 2160 pixels (2D-4 K) seems to improve laparoscopic view and helps learners orient without stereopsis. However, evidence comparing these systems for laparoscopic training is limited. Therefore, the impact of viewing mode (2D-4 K vs. 3D) on learning and task proficiency remains unclear.DesignWe performed a two-hour teaching intervention on basic laparoscopic skills for novices. In this parallel group randomized study, we randomly assigned learners to 2D-4 K or 3D teaching and performed tasks of increasing difficulty and complexity using standard laparoscopy box trainers. Before the last and most challenging task, learners had to crossover to the other laparoscopy setup. Our hypothesis was that learners would be faster and more precise when using a 3D setup. The primary endpoint was task proficiency measured by speed and failure rate. Secondary outcomes were performance using the viewing mode of the other group without familiarization, self-perception, and career aspirations before and after the teaching intervention, expressed on a Likert scale.SettingThe study was performed by the Department of General, Visceral and Thoracic Surgery at the German Armed Forces Hospital Ulm, which is an academic teaching hospital of the University of Ulm.ParticipantsThirty-eight laparoscopic novices, including medical students and junior residents, participated voluntarily in this teaching intervention. Group allocation was performed via the virtual coin flip method. Apparently, participants and tutors were not blinded to group assignment. No formal approval by the ethics committee was needed for this noninvasive study in compliance with the World Medical Association Declaration of Helsinki as discussed with the ethics committee of the University of Ulm.ResultsThirty-eight laparoscopy novices were randomized in the study. The 3D group (n = 19) was significantly faster than the 2D-4 K group (n = 19) (p = .008) in a standard box trainer model, with 134.45 ± 41.45 s vs. 174.99 ± 54.03 s for task 1 and 195.97 ± 49.78 s vs. 276.56 ± 139.20 s for task 2, and the effect was consistent throughout the learning curve. The failure rate was not significantly affected by the viewing mode. After crossover to the other laparoscopy system, precision and time were not significantly different between the groups. Learners rated the difficulty of laparoscopy lower on a Likert scale after having two hours of basic laparoscopy training. The study was funded by the hospital’s teaching budget.ConclusionsLaparoscopic novices can benefit from a 3D laparoscopy training setup. Exclusive 3D training prior to a complex task on a 2D-4 K setup does not negatively affect the learner’s performance.

Clinical Outcomes of Complete Mesocolic Excision for Right-Sided Colon Cancer Using 3D Laparoscopy versus 2D Laparoscopy

Objective: To study the clinical outcomes of complete mesocolic excision (CME) for right-sided colon cancer using 3D (three-dimensional) laparoscopy compared to 2D (two-dimensional) laparoscopy. Methods: From January 2022 to December 2023, 58 patients with right-sided colon cancer treated at the Affiliated Hospital of Hebei Engineering University were randomly divided into a 3D laparoscopy group (observation group) and a 2D laparoscopy group (control group), with 29 patients in each group. Intraoperative blood loss, postoperative time to first flatulence, length of hospital stay, and incidence of complications in both groups were recorded. Results: There was a statistically significant difference in intraoperative blood loss between the two groups (P < 0.05). There was no statistically significant difference in the time to first flatulence between the groups (P > 0.05). However, there was a statistically significant difference in the length of hospital stay (P < 0.05) and the incidence of complications (P < 0.05) between the two groups. Conclusion: 3D laparoscopy for CME can reduce intraoperative blood loss, shorten hospital stay, and decrease postoperative complications, showing significant clinical advantages over traditional 2D laparoscopy.

A retrospective study of 3D laparoscopy and 2D laparoscopy in transabdominal preperitoneal (TAPP) for unilateral inguinal hernia in elderly patients.

This study aims to explore the safety and efficacy of 3D laparoscopy in elderly patients undergoing transabdominal preperitoneal (TAPP) surgery for inguinal hernia. Patients were divided into two groups based on the laparoscopic equipment used during surgery. Clinical data preoperatively, intraoperatively, and postoperatively were collected and subjected to statistical analysis. From January 2020 to August 2023, a total of 127 patients with primary unilateral inguinal hernia were evaluated in this study, 61 in the 3D TAPP group and 66 in the 2D TAPP group. There were no statistically significant differences in baseline data, including average age, gender distribution, BMI index, hernia type, hernia defect size and location, comorbidities, and usage of anticoagulant drugs between the two groups (P > 0.05). In terms of operative indicators, the 3D group showed shorter mean operation time (51.61 ± 7.16min vs. 78.59 ± 13.51min, P < 0.001), mean mesh placement time (6.07 ± 1.40min vs. 9.77 ± 1.21min, P < 0.001), and mean peritoneal suture time (7.34 ± 1.85min vs. 9.73 ± 1.32min, P < 0.001) compared to the 2D group. However, there were no statistically significant differences in mean blood loss, postoperative pain scores, postoperative hospital stay, and total hospital costs between the two groups (P > 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05). No adverse reactions such as dizziness or nausea were reported by surgeons during the procedures in either group. Three-dimensional laparoscopy in TAPP surgery provides high-definition, three-dimensional surgical images, reducing the difficulty of operations and effectively shortening the operation time.

Advantages of the 3- vs. the 2-Dimensional Laparoscopic Technology in Bariatric Surgery

Abstract Background Bariatric surgery procedures as the laparoscopic Roux-en-Y-Gastric Bypass (RYGB) are highly standardized procedures. The difficulty in two-dimensional (2D) laparoscopic surgery is the loss of the depth perception which complicates surgical techniques as suturing and knotting. The development of three-dimensional (3D) laparoscopy has been shown to reduce operative times and surgeons’ performances errors. Aims To compare operative times, post-operative complications and the lengths of hospital stay of patients having undergone laparoscopic RYGB before and after the introduction of the 3D-technology. Methods We conducted a retrospective cohort study including patients having undergone RYGB (without cholecystectomy) at our institution by the same surgical team before and after the introduction of the 3D-laparoscopic technology (Karl Storz, Tuttlingen, Germany). The primary outcome was the operative time, the secondary outcomes the post-operative complications and lengths of hospital stay. Results 100 consecutive patients, operated on 2019-2021 were included; 50 were operated utilizing the 2D- and 50 the 3D laparoscopic technology. There were no statistically significant differences in age, gender, body mass index or comorbidities, however, patients in the 3D-group had significantly more previous interventions. Operative time and hospital length of stay were significantly reduced in the 3D-group (83 (± 20.8) vs. 91 (± 13.5) minutes; p &amp;lt; 0.05 and 2.1 (± 0.4) vs. 2.7 (± 1.1) nights; p &amp;lt; 0.05). There were no statistically significant differences found between groups concerning post-operative complications and re-interventions. Conclusion 3D technology may help reducing the operative time and length of hospital stay in laparoscopic RYGB surgery with similar post-operative complications. We cannot completely exclude reduced operative times by the still growing experience of the surgical team.

Laparoscopy training of novices with complex curved instruments using 2D- and 3D-visualization

PurposeBeside many advantages, disadvantages such as reduced degrees of freedom and poorer depth perception are still apparent in laparoscopic surgery. 3D visualization and the development of complex instruments are intended to counteract the disadvantages. We want to find out whether the use of complex instruments and 3D visualization has an influence on the performance of novices.Methods48 medical students with no experience in laparoscopic surgery or simulator-based laparoscopy training were included. They were randomized in four groups according to a stratification assessment. During a structured training period they completed the FLS-Tasks “PEG Transfer”, “Pattern Cut” and “Intracorporeal Suture” and a transfer task based on these three. Two groups used conventional laparoscopic instruments with 3D or 2D visualization, two groups used complex curved instruments. The groups were compared in terms of their performance.ResultsIn 2D laparoscopy there was a better performance with straight instruments vs. curved instruments in PEG Transfer and Intracorporeal Suture. In the transfer task, fewer errors were made with straight instruments. In 2D vs. 3D laparoscopy when using complex curved instruments there was an advantage in Intracorporeal Suture and PEG Transfer for 3D visualization. Regarding the transfer exercise, a better performance was observed and fewer errors were made in 3D group.ConclusionWe could show that learning laparoscopic techniques with complex curved instruments is more difficult with standard 2D visualization and can be overcome using 3D optics. The use of curved instruments under 3D vision seems to be advantageous when working on more difficult tasks.

Comparison of 3D and 2D laparoscopy: Initial experience of perioperative outcomes and clinical assessment

IntroductionThis study was designed to compare three-dimensional (3D) laparoscopy and conventional two-dimensional (2D) laparoscopy in surgical performance and clinical assessment during laparoscopic radical hysterectomy with pelvic lymphadenectomy (LRHND) for treating early-stage cervical cancer. Material and methodsIn this study, we included 67 consecutive patients underwent LRHND for treating early-stage cervical cancer by the experienced laparoscopic surgeons between August 2018 and December 2020. amongst these patients, 32 patients underwent 3D laparoscopy (2D group) and 35 patients underwent 2D laparoscopy (2D group). Demographic data, clinical and surgical parameters were obtained from each patient. An end-of-operation questionnaire was administered regarding subjective perception of 3D laparoscopy system. ResultsPatient characteristics, including age, BMI, FIGO stage, and histology, were comparable between the two groups. Compared with 2D imaging system, 3D system significantly shortened the operation time, especially bilateral lymph node dissection time. Blood loss was lower in 3D group compared with 2D group. There were no significant differences regarding pelvic nodes retrieved, incidence of complications, hospital stay, the recovery time of bowel, abdominal drainage fluid, hospitalization costs and visual symptoms. In addition, 3D system significantly improved depth perception and precision, and reduced surgical strain and eye strain for surgeon. No statistical difference was observed in visual symptoms and adverse events between the two groups. The surgeon was more willing to accept 3D laparoscopy. ConclusionThe 3D laparoscopy is safe, feasible and comfortable, with obvious advantage in depth perception, precision and surgical strain. It triggered no increase in the complications and adverse events.

Comparative study of each surgical step in radical prostatectomy under 3D and 2D laparoscopy.

Comparing the specific advantages and surgical outcomes of each step in radical prostatectomy under 3D vs. 2D laparoscopy. From October 2019 to January 2023, our urology department treated 63 cases of prostate cancer, using an odd-even arrangement method to divide into two groups. This is a non-randomized prospective study, with 33 odd-numbered cases in the 3D group and 30 even-numbered cases in the 2D group. The surgery was divided into four steps: (1) establishing an extraperitoneal pneumoperitoneum (2) pelvic lymph node dissection (3)excising the prostate (4)bladder-urethral anastomosis, comparing the two groups in terms of surgical time, blood loss, and relevant postoperative indicators for each step. All 63 surgeries were successfully completed without any conversions. Comparing 3D and 2D laparoscopy groups, there were statistically significant differences in total surgery time (123.5 ± 15.3 min vs. 145.6 ± 17.2 min, P < 0.05), total blood loss (198.3 ± 18.4 ml vs. 243.1 ± 20.1 ml, P < 0.05), prostate excision time (55.1 ± 8.4 min vs. 67.2 ± 9.3 min, P < 0.05) and blood loss (101.6 ± 12.2 ml vs. 123.8 ± 14.1 ml, P < 0.05), bladder-urethral anastomosis time (30.5 ± 4.3 min vs. 37.6 ± 5.1 min, P < 0.05) and blood loss (62.7 ± 9.7 ml vs. 82.5 ± 8.2 ml, P < 0.05). There were no statistical differences in the time and blood loss during the establishment of extraperitoneal pneumoperitoneum and the cleaning of pelvic lymph nodes (P > 0.05). In terms of urinary incontinence rates, the 3D laparoscopy group was lower than the 2D group, and in terms of preserving erectile function, the 3D group was higher than the 2D group, with significant statistical differences (P < 0.05). There were no statistically significant differences between the two groups in terms of postoperative drainage days, hospitalization days, hospitalization costs, time of catheter removaland positive margin rates (P > 0.05). Compared to traditional 2D laparoscopy, 3D laparoscopy can shorten the operation time and reduce bleeding in the steps of prostate excision and bladder-urethral anastomosis, but there was no significant difference in peri-operative outcomes.

Effect of 3D laparoscopy versus traditional laparotomy on serum tumor markers and coagulation function in patients with early-stage endometrial cancer

ObjectivesTo investigate the impact of Three-Dimensional (3D) laparoscopy compared to traditional laparotomy on serum tumor markers and coagulation function in patients diagnosed with early-stage Endometrial Cancer (EC). MethodThe authors retrospectively analyzed the clinical data of 75 patients diagnosed with early-stage EC and categorized them into two groups based on the surgical techniques employed. The 3D group consisted of 36 patients who underwent 3D laparoscopic surgery, while the Laparotomy group comprised 39 patients who underwent traditional laparotomy. The authors then compared the alterations in serum tumor markers and coagulation function between the two groups. ResultsPostoperatively, serum levels of CA125, CA199, and HE4 were notably reduced in both groups on the third day, with the levels being more diminished in the 3D group than in the Laparotomy Group (p < 0.05). Conversely, FIB levels escalated significantly in both groups on the third-day post-surgery, with a more pronounced increase in the 3D group. Additionally, PT and APTT durations were reduced and were more so in the 3D group than in the laparotomy group (p < 0.05). ConclusionsWhen juxtaposed with traditional laparotomy, 3D laparoscopic surgery for early-stage EC appears to be more efficacious, characterized by reduced complications, and expedited recovery. It can effectively mitigate serum tumor marker levels, attenuate the inflammatory response and damage to immune function, foster urinary function recovery, and enhance the quality of life. However, it exerts a more significant influence on the patient's coagulation parameters, necessitating meticulous prevention and treatment strategies for thromboembolic events in clinical settings.

Development and validation of a simulation training platform for the ligation of deep dorsal vein complex in radical prostatectomy.

This study aimed to design a low-cost, simulation training platform for the ligation of deep dorsal vein (DVC) complex in radical prostatectomy and validate its training effectiveness. A simplified prostate urethra model was produced by 0-degree silica gel and pulse pressure banding. This model was placed on a slope of about 30 degrees using cardboard to thus creating a narrow environment of the pelvis. The DVC ligation was performed by a 2D laparoscopy simulator. A total of 27 participants completed the study include 13 novices, 10 surgical residents and 4 urology experts. The novices were trained five trails with 24 hours interval, the residents and experts completed the DVC ligation once. The construct validity of this simulation training platform was performed by completing time, the GOALS (Global Operative Assessment of Laparoscopic Skills) and TSA (i.e. Task Specific Assessments) score. The face validity and content validity were performed by a specific closed-ended questionnaire. There was no significant difference among three groups in demographic or psychometric variables (p > 0.05). Compared to the novices, the residents spend a shorter time to complete the DVC ligation (p < 0.05) and had higher GOALS scores (p < 0.05), but had no significant difference in TSA scores (p > 0.05). Additionally, the experts groups had a better performance compared to residents group in the completing time (p < 0.05), GOALS score (p < 0.05) and TSA score (p < 0.05). The learning curve of novices significantly promoted along with the increased times of training. Almost 90 percent of subjects considered that this simulator had a good performance in the realism and practicability. We developed a novel low-cost a simulation training platform for the ligation of deep dorsal vein complex in radical prostatectomy, and this simulator had a good performance in the construct validity, face validity and content validity.

Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study.

To compare the effect of three-dimensional (3D) and two-dimensional (2D) laparoscopy on surgical time and intraoperative complications during cholecystectomies in canine cadavers. Experimental prospective study. Twelve canine cadavers. The laparoscopic cholecystectomies were performed in canine cadavers with four cannulas and with either 2D or 3D cameras by a single surgeon. The following surgical times were recorded: time from insertion of laparoscopic instruments to first endoclip placement, time from first endoclip placement to second endoclip placement, time from second endoclip placement to complete gall bladder dissection, and total surgical time. The cystic duct length distal to the first endoclip, intraoperative complications, and the amount of liver attached to the gall bladder were also recorded. Time from the insertion of the instruments to the application of the first endoclip was shorter for the 3D group than for the 2D group (p = .016). Other surgical times were not different between groups. There was no difference in the cystic duct length distal to the first endoclip, intraoperative complications, or the amount of liver attachment. Three-dimensional laparoscopy shortened the time from insertion of the laparoscopic instruments to placement of the first endoclip. However, total surgical time was not affected by the type of camera in laparoscopic cholecystectomy. Three-dimensional laparoscopy may be beneficial when performing procedures requiring enhanced spatial orientation. However, this technique did not shorten the total surgical time in this cadaveric study. Further studies in a clinical setting are necessary for the optimization of the future use of 3D laparoscopy.

Short and Long-term Efficacy of 3-dimensional Laparoscopic-assisted D2 Radical Gastrectomy Under the Guidance of Membrane Anatomy for Locally Advanced Gastric Cancer.

Both 3-dimensional (3D) laparoscopy and membrane anatomy are topics of great interest in the treatment of gastric cancer. The purpose of this study was to evaluate the safety, feasibility, and efficacy of 3D laparoscopic-assisted D2 radical gastrectomy for locally advanced gastric cancer (LAGC) under the guidance of membrane anatomy. Retrospectively analyzed the clinical data of 210 patients who underwent 2-dimensional (2D)/3D laparoscopic-assisted D2 radical gastrectomy under the guidance of membrane anatomy for LAGC. Compared the differences between the two groups in surgical outcomes, postoperative recovery, postoperative complications, and 2-year overall survival and disease-free survival. The baseline data of the 2 groups were comparable (P > 0.05). The amount of intraoperative bleeding in the 2D and 3D laparoscopy groups was 100.1 ± 48.75mL and 74.29 ± 47.33mL, respectively, with a significant difference between the two groups (P < 0.001). The time to first exhaust and first liquid diet intake and length of postoperative hospital stay was shorter in the 3D laparoscopy group, with significant differences between the two groups [3 (3-3) days vs 3(3-2) days, P = 0.009; 7 (8-7) days vs 6 (7-6) days, P < 0.001; and 13 (15-11) days vs 10 (11-9) days, P < 0.001]. There were no significant differences in operation time, number of lymph node dissections, incidence of postoperative complications, or 2-year overall survival and disease-free survival between the two groups (P > 0.05). Three-dimensional laparoscopic-assisted D2 radical gastrectomy for LAGC under the guidance of membrane anatomy is safe and feasible. It can reduce intraoperative bleeding, accelerate postoperative recovery, and does not increase operative complications, the long-term prognosis is similar to that of the 2D laparoscopy group.

3D versus 2D laparoscopic distal gastrectomy in patients with gastric cancer: a systematic review and meta-analysis.

While laparoscopic gastrectomy is a prominent therapeutic approach for distal gastric cancer, the clinical benefits of 3D laparoscopy over 2D laparoscopy remain unclear. We aimed to compare the clinical outcomes of 3D laparoscopy and 2D laparoscopy for distal gastric cancer resection through a systematic review and meta-analysis. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published from inception through January 2023, according to the PRISMA guidelines. The MD or RR was used to compare 3D and 2D distal gastrectomy. Random-effects meta-analysis was estimated using the inverse variance and Mantel-Haenszel method for binary outcomes and the DerSimonian-Laird estimator for continuous outcomes. After reviewing 559 studies, 6 manuscripts met the inclusion criteria. The analysis included 689 patients, with 348 (50.5%) in the 3D group and 341 (49.5%) in the 2D group. 3D laparoscopic gastrectomy reduces the operative time (WMD - 28.57min, 95% CI - 50.70 to - 6.44, p = 0.011), intraoperative blood loss (WMD - 6.69mL, 95% CI - 8.09 to - 5.29, p < 0.001), and postoperative hospital stay (WMD - 0.92days, 95% CI - 1.43 to - 0.42, p < 0.001). There were no significant differences in time to first postoperative flatus (WMD - 0.22days, 95% CI - 0.50 to 0.05, p = 0.110), postoperative complications (Relative Risk 0.56, 95% CI 0.22 to 1.41, p = 0.217), and the number of retrieved lymph nodes (WMD 1.25, 95% CI - 0.54 to 3.03, p = 0.172) between 3 and 2D laparoscopic distal gastrectomy. Our study highlights the potential advantages of 3D laparoscopy in distal gastrectomy, including shorter operative time, postoperative hospital stay, and decreased intraoperative blood loss.

Initial experience with 3D laparoscopic choledochal cyst (CDC) excision and hepatico-duodenostomy (HD) in 21 children.

Minimal access surgery has gradually become the standard of care in the management of choledochal cysts (CDC). Laparoscopic management of CDC is a technically challenging procedure that requires advanced intracorporeal suturing skills, and hence, has a steep learning curve. Robotic surgery has the advantages of 3D vision, articulating hand instruments making suturing easy and thusis ideal. However, the non-availability, high costs and necessity for large-size ports are the major limiting factors for robotic procedures in the paediatric population. Use of 3D laparoscopy incorporates the advantage of 3D vision and at the same time allows the use of small-sized conventional laparoscopic instruments. With this background, we discuss our initial experience with the use of 3D laparoscopy using conventional hand instruments in CDC management. To study our initial experience in the management of CDC in paediatric patients with 3D laparoscopy in terms of feasibility and peri-operative details. All patients under 12years of age treated for choledochal cyst in a period of initial 2years were retrospectively analysed. Demographic parameters, clinical presentation, intra-operative time, blood loss, post-operative events and follow-up were studied. The total number of patients were 21. The mean age was 5.3years with female preponderance. Abdominal pain was the most common presenting symptom. All patients could be completed laparoscopically. No patient needed conversion to open procedure or re-exploration. The average blood loss was 26.67ml. None of the patients required a blood transfusion. One patient developed a minor leak postoperatively and was managed conservatively. 3D laparoscopic management of CDC in the paediatric age group is safe and feasible. It offers the advantages of depth perception aiding intracorporeal suturing, with the use of small-sized instruments. It is thus a 'bridging the gap' asset between conventional laparoscopy and robotic surgery. Treatment study level IV.

Three-Dimensional Versus Two-Dimensional Laparoscopy in Laparoscopic Liver Resection: A Systematic Review and Meta-Analysis.

Background: Three-dimensional (3D) laparoscopy provides stereopsis and may reduce operating time (OT) and morbidity. However, there is a paucity of literature on its use in laparoscopic liver resection (LLR). This study aims to compare outcomes between 3D and two-dimensional (2D) LLR. Materials and Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched from inception to November 2022. The inclusion criterion was studies comparing intraoperative characteristics and/or postoperative outcomes between 3D and 2D LLR. Studies on the use of 3D image reconstruction techniques for preoperative planning were excluded. Primary outcomes were OT, estimated blood loss (EBL), and overall morbidity. Secondary outcomes were other postoperative complications, need for reoperation, and in-hospital mortality. Results: Four studies with 361 patients (3D: n = 159, 2D: n = 202) were included. There were 65.3% males (overall: n = 236/361). Age, sex, body-mass index, incidence of diabetes mellitus, hepatitis B and/or C carrier, receipt of neoadjuvant chemotherapy, tumor size, and incidence of multiple tumors were comparable between 3D and 2D LLR. No studies reported on Child-Pugh status. One study included only patients with hepatocellular carcinoma, two studies included patients with mixed histopathology, and one study did not report on histopathology. There was no significant difference in OT (mean difference [MD] -31.6 minutes, 95% confidence interval [CI]: -89.7 to 26.5), EBL (MD -454.1 mL, 95% CI: -978.8 to 70.6), need for reoperation (odds ratio [OR] 0.91, 95% CI: 0.18-4.61), and in-hospital mortality (OR 0.52, 95% CI: 0.06-5.50) between 3D and 2D LLR. Overall morbidity was lower in 3D LLR (OR 0.56, 95% CI: 0.32-0.98, P = .04). However, the learning curve (LC) was not described in the included studies and may confound outcomes. Conclusions: 3D LLR may reduce overall postoperative morbidity compared with 2D LLR, but results may be confounded by the lack of standardization of surgeons' experience and the LC of 3D LLR.

Prospective randomized comparison of three-dimensional (3D) versus conventional laparoscopy in total colectomy for ulcerative colitis.

3D laparoscopy has been proposed with the aim of improving the depth perception and overall operative performance. To aim of this study is to compare 3D laparoscopy with conventional 2D laparoscopy in terms of operative time and visual parameters. This is a prospective, randomized, single-center trial designed to determine 10% reduction in the mean operative time. Ulcerative colitis patients >18 years of age who underwent laparoscopic total abdominal colectomy with end ileostomy between 2015 and 2020 were included. Patients were randomized into 3D and 2D laparoscopy groups. Duration of operation and surgeons' evaluation of the visualization system were the primary outcomes. Fifty-three subjects (26 in 2D, 27 in 3D group) were included in the analysis, with 56% being male. Mean age and body mass index were 40 (16.3) years and 23.5 (4.7) kg/m2 , respectively. Twenty-five subjects underwent single port laparoscopic surgery, of whom 13 were in 3D and 12 in 2D group. Mean operative time was 75.3 (30.8) versus 82.7 (38.6) minutes (P=0.4) for 3D and 2D groups, respectively. Operative times spent for individual steps were comparable. Post-operative minor complications (8 in 3D versus 8 in 2D, P=1) and median number of times for scope maintenance were also similar between the groups. 69% of the visual evaluation survey results favoured 3D over 2D (P=0.014). Three-dimensional laparoscopy for total colectomy in ulcerative colitis patients is safe and feasible option providing better visualization with no difference in operative time.

Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis.

Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4K 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 -0.69p < 0.00001), suturing (MD: -0.48; 95% CI -0.83 to -0.13p = 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.

Intraoperative laparoscopic liver surface registration with preoperative CT using mixing features and overlapping region masks.

Laparoscopic liver resection is a minimal invasive surgery. Augmented reality can map preoperative anatomy information extracted from computed tomography to the intraoperative liver surface reconstructed from stereo 3D laparoscopy. However, liver surface registration is particularly challenging as the intraoperative surface is only partially visible and suffers from large liver deformations due to pneumoperitoneum. This study proposes a deep learning-based robust point cloud registration network. This study proposed a low overlap liver surface registration algorithm combining local mixed features and global features of point clouds. A learned overlap mask is used to filter the non-overlapping region of the point cloud, and a network is used to predict the overlapping region threshold to regulate the training process. We validated the algorithm on the DePoLL (the Deformable Porcine Laparoscopic Liver) dataset. Compared with the baseline method and other state-of-the-art registration methods, our method achieves minimum target registration error (TRE) of 19.9 ± 2.7mm. The proposed point cloud registration method uses the learned overlapping mask to filter the non-overlapping areas in the point cloud, then the extracted overlapping area point cloud is registered according to the mixed features and global features, and this method is robust and efficient in low-overlap liver surface registration.

The experience of 100 cases of 8K/two-dimensional laparoscopic colorectal surgery - The evaluation of 8K/two-dimensional laparoscopy and how to use it.

The resolution of 8K ultra-high-definition imaging technology (7680 × 4320 pixels) is 16-fold higher than the current high-definition technology (1920 × 1080 pixels). 8K/two-dimensional (2D) laparoscopy was clinically available in 2014, but few reports concerning its application have been published. The aim of this study was to evaluate the appropriate methods of usage and problems learned from clinical use of 8K/2D laparoscopy. The patients were 100 colorectal surgery patients who underwent 8K/2D laparoscopy at Asahikawa Medical University Hospital between November 2018 and March 2021. We evaluated the effectiveness, operating conditions, methods and issues of 8K/2D laparoscopy. The median age was 68.5 years. The primary disease was malignancy of the left side of the colon and rectum in 92 patients. The right-sided colectomy was performed in five cases, total proctocolectomy of ulcerative colitis was performed in 3 cases. The proper application of 8K/2D laparoscopy can be achieved by adhering to certain tips, such as darkening the operation room and keeping an appropriate distance from the monitor. Regarding intraoperative complications caused by the 8K/2D laparoscope, skin burns due to heat from the tip of the laparoscope were observed in one patient. There were no cases of complications due to the 8K/2D laparoscopy. 8K/2D laparoscopy can be used safely in colorectal surgery. There are still some tips for proper use, such as keeping an appropriate distance to the monitor and darkening the room. However, 8K/2D laparoscopy can provide delicate images and can be used without any operational problems.

Three-dimensional vs two-dimensional endoscopic approach in urogynecology: A retrospective cohort study of laparoscopic sacrocolpopexy.

The gold standard to treat an apical pelvic organ prolapse is the abdominal route via a sacrocolpopexy, which is also reproduced by laparoscopic route. A laparoscopic sacrocolpopexy however, requires surgical expertise. Three-dimensional (3D) laparoscopy has been developed to overcome the lack of depth perception, that is a known disadvantage of conventional two-dimensional (2D) laparoscopy. This procedure can accelerate the learning curve and optimize the intra-, peri-, and postoperative outcomes. This study aims to compare 3D laparoscopy to traditional 2D laparoscopy for sacrocolpopexy. Data from 132 patients who underwent a sacrocolpopexy with 2D or 3D laparoscopy in Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University, between June 2012 and September 2021, were collected retrospectively. Seventy-one laparoscopic sacrocolpopexy operations in 2D (n=23) and 3D (n=48) group were reviewed and compared regarding the duration of surgery, blood loss and the length of hospital admission as primary objectives. There were no differences in the baseline demographics between the two groups. The estimated blood loss (1.0 (±0.6) g/dL vs 1.7 (±1.0) g/dL, p=0.010), and duration of surgery (115.4 (±34.7) min. vs 134.7 (±26.2) min., p=0.012) was significantly better in favor of 3D laparoscopy. The length of hospital stay was comparable in both groups (p=0.833). Furthermore, no differences were observed between the groups regarding other surgical outcomes. 3D laparoscopy shows a significant benefit in terms of estimated blood loss and surgery duration among complex urogynecological surgeries compared to traditional 2D laparoscopy.

Second Look Laparoscopy Surgery Boon for Fully Treated Patients of CA Ovary but Raising CA 125 Levels and Localised Tumors

Study Objective To define role of 2nd look laparoscopy in fully treated in Ca ovary patient with persistent raised Ca 125 levels. Design Prospective analysis. Setting Patient undervent 3D laparoscopy, all procedures done by experienced and qualified team. Patients or Participants Fully treated Ca ovary patient with raised Ca 125 levels. Interventions 2nd look laparoscopy with excision of Case1- Retroperitoneal solid cystic mass near left iliac vessels. Case 2- Aortocaval (para-aortic) node. Case 3- solid cystic recurrent mass from remnant of left ovary. Case 4- Peritoneal deposit from anterior abdominal wall and omental nodule. Measurements and Main Results all the patient reviewed at monthly interval followed by 3 monthly interval with Ca 125 level & 3 monthly USG (A+P), none of the patient needed further chemotherapy as Ca 125 continues to be normal and USG (A+P) WNL, PET scan done at the end of 6 months did not reveal any evidence of recurrence. Median follow-up 18 months. All patients are diseased free. Conclusion 2nd look laparoscopy was always an armamentarium for gynecologist but using laparoscopy 2nd look surgery become beneficial for specific group of patients with persistent raised CA125 level & no major recurrence on imaging. To define role of 2nd look laparoscopy in fully treated in Ca ovary patient with persistent raised Ca 125 levels. Prospective analysis. Patient undervent 3D laparoscopy, all procedures done by experienced and qualified team. Fully treated Ca ovary patient with raised Ca 125 levels. 2nd look laparoscopy with excision of Case1- Retroperitoneal solid cystic mass near left iliac vessels. Case 2- Aortocaval (para-aortic) node. Case 3- solid cystic recurrent mass from remnant of left ovary. Case 4- Peritoneal deposit from anterior abdominal wall and omental nodule. all the patient reviewed at monthly interval followed by 3 monthly interval with Ca 125 level & 3 monthly USG (A+P), none of the patient needed further chemotherapy as Ca 125 continues to be normal and USG (A+P) WNL, PET scan done at the end of 6 months did not reveal any evidence of recurrence. Median follow-up 18 months. All patients are diseased free. 2nd look laparoscopy was always an armamentarium for gynecologist but using laparoscopy 2nd look surgery become beneficial for specific group of patients with persistent raised CA125 level & no major recurrence on imaging.