3D Laparoscopy Research Articles

Experience of application of 3D-visualization in laparoscopic operations

Objective. Studying of first results of application of 3D visualization in various laparoscopic interventions.
 Materials and methods. There were performed 169 operations: 27 transabdominal preperitoneal plasties of inguinal hernias, 19 intraperitoneal alloplasties of umbilical and postoperative ventral hernias with suturing of hernia defect, 1 retromuscular alloplasty of umbilical hernia, 6 reconstructions of anterior abdominal wall for dyastasis of rectal abdominal muscles, 103 plasties of hiatal hernias with fundoplications, 7 Heller’s cardiomyotomies and Dor’s fundoplication, 1 subtotal, 3 atypical gastric resections and 2 sleeve gastric resections for obesity.
 Results. 3D laparoscopy have simplified and accelerated the parietal peritoneum suturing in conduction of transabdominal preperitoneal plasties of inguinal hernias, as well as while performance of intraperitoneal alloplasties of umbilical and postoperative ventral hernias – the hernia defect suturing. While doing the hiatal hernia plasty, fundoplication with crurorrhaphy 3D laparoscopy have provided the additional advantages of manipulations improvement in special anatomic zones. Analogous advantages were shown in gastric operations, using 3D visualization. Intra- and postoperative complications were absent, as well as the hernias recurrence in the 6 mo-1.5 yr follow-up.
 Conclusion. The 3D visualization guarantees a rapid and highly-precision performance of complex manipulations in technically hard anatomical zones. Further accumulation of the material and comparison of results of 3D and 2D laparoscopy in prospective investigations, using objective parameters, as well as studying of expediency for 3D visualization selective application, for instance while performance of the most complicated operative stages are necessary.

Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison.

We describe our preliminary experience in complete mesocolic excision (CME) with central vascular ligation (CVL) and intracorporeal anastomosis for right colon cancer, comparing the robotic and the three-dimensional (3D) laparoscopic approach. We performed a retrospective observational clinical cohort study on patients who underwent radical curative surgical resection of right colon cancer with CME from January 2014 to June 2019. Propensity scores were calculated by bivariate logistic regression, including the following variables: age, BMI, and size of tumor. Fifty-five patients underwent CME with CVL: 26 by means of robot-assisted surgery and 29 by means of 3D laparoscopic procedure. There were not statistically significant differences about all the intra- and postoperative outcomes (operative time, length of the specimen, time to bowel canalization, time to soft oral intake, length of hospital stay, postoperative complication, number of retrieved lymph nodes, number of positive lymph nodes and lymph node ratio) between the robotic and the 3D laparoscopic approach. After the matching procedure, 20 patients of the robotic group and 20 patients of the 3D laparoscopic group were selected for the analysis. There were no differences in any of the analyzed variables between the two groups except for longer operative time in the robotic group (p = 0.002). The 3D vision revealed an important advantage in order to achieve the correct identification of surgical anatomy allowing a safe and effective right colectomy with CME, CVL, and intracorporeal anastomosis, either using laparoscopic or with robotic approach, providing similar short-term outcomes. Taking into account the high costs and the longer operative time of robotic procedure, the 3D laparoscopy could be considered in performing right colectomy with CME, while the robotic approach should be considered as a first choice approach for challenging situations (obese patient, complex associated procedures).

Prospective randomized controlled study for comparison of 2-dimensional versus 3-dimensional laparoscopic distal gastrectomy for gastric adenocarcinoma.

Due to the technological advance in resolution and stereoscopic depth, the 3-dimensional (3D) laparoscopic system has been widely used in real surgery. However, there have been few studies to confirm the clinical usefulness of the 3D laparoscopic distal gastrectomy (LDG). This study aimed to compare perioperative outcomes between the 2-dimensional (2D) and 3D LDG for gastric cancer patients. This was a prospective, randomized controlled, single-center, and superiority trial. This study was carried in Seoul National University Bundang Hospital. Patients with histologically confirmed gastric adenocarcinoma which could be radically resected by LDG were randomly assigned (1:1) to the 2D or 3D group. From October 2016 to August 2018, 84 patients were included in this study and randomly assigned into the 2D group (44 patients) or the 3D group (40 patients). A total of 5 patients were excluded; 3 in the 2D group and 2 were in the 3D group. Consequently, the data from 79 patients were analyzed (2D: 41 cases; 3D: 38 cases). For the LDG procedure, 3D and 2D camera and display system were applied according to the assigned group. The primary end point was the duration of total laparoscopic operation time. Secondary end points included the amount of intraoperative blood loss (IBL), the number of harvested lymph nodes, postoperative complications and open conversion rate. There were no differences between 2 and 3D groups with respect to clinicopathologic characteristics. The total operation time in 3D groups was significantly shorter than 2D group (122 [106.5-161] versus 101 [77.75-125.5] minutes; P = 0.001). The postoperative complication rates in the 3D groups was significantly lower than 2D group (24.4% versus 7.9%, respectively; P = 0.045). 3D LDG shorten the operation time compared with 2D LDG in gastric cancer patients. And 3D laparoscopy provided the benefit of less postoperative complications. cris.nih.go.kr number KCT0003717.

Incidence and severity of Visually Induced motion Sickness during 3D laparoscopy In Operators who had No experience with it (VISION).

AimThe aim of the study was to evaluate the incidence and severity of visually induced motion sickness (VIMS) during 3D laparoscopy, in operators without prior experience.Material and methodsDesign: A retrospective comparative study (Canadian Task Force classification II-2). Setting: A university hospital. Intervention: Gynecologic surgery. Main outcome measure: This is a prospective observational study, which enrolled 9 surgeons as participants. None of these surgeons had any prior experience with 3D laparoscopy. Each participant performed 10 consecutive cases of 3D laparoscopy in patients with benign or premalignant gynecological diseases. The primary outcome measure was the incidence and severity of VIMS, which was evaluated using the validated Simulator Sickness Questionnaire. Personal preferences, discomfort, and ease of 3D laparoscopy were also evaluated.ResultsSixty-seven percent of surgeons experienced VIMS during their first 3D laparoscopy case. The incidence and severity of VIMS dramatically decreased from the second case onward. However, in some surgeons (22–44%), VIMS did not completely disappear until the tenth case. With respect to the discomfort using 3D laparoscopy, 84 self-reported responses after each surgery were “favor 3D laparoscopy,” and “no” in 61 (72.6%) and 47 (55.9%) participants, respectively. Most participants found it easier to perform 3D laparoscopy than 2D laparoscopy.ConclusionsThe occurrence of visually induced symptoms in susceptible individuals during 3D laparoscopy is high, particularly during their first case. This suggests the need for increasing surgeons’ awareness regarding the possibility of discomfort.

Laparoscopic Appendectomy Performed by junior SUrgeonS: impact of 3D visualization on surgical outcome. Randomized multicentre clinical trial. (LAPSUS TRIAL)

The purpose of this study was to evaluate the effect of 3D visualization applied to laparoscopic appendectomy (LA) performed by young surgeons (YS). We considered both operative features and clinical outcomes, aiming to highlight the benefits that this technology could bring to novice surgeons and their laparoscopic training. All the surgical procedures were performed by residents who had performed less than 20 appendectomies prior to the beginning of the study under the supervision of an expert surgeon. At the time of enrolment patients were randomized into two arms: Experimental arm (EA): laparoscopic appendectomy performed with laparoscopic 3D vision technology. Control arm (CA): laparoscopic appendectomy performed with the "standard" 2D technology. The primary endpoint was to find any statistically significant difference in operative time between the two arms. Differences in conversion rate, intra-operative complications, post-operative complications and surgeons' operative comfort were considered as secondary endpoints. We randomized 135 patients into the two study arms. The two groups were homogeneous for demographic characteristics, BMI and ASA scores. The characteristics of clinical presentation and anatomical position showed no significant difference. The operative time was longer in the CA (57.5 vs. 49.6min, p = 0.048, 95% CI). In the subgroup of complicated appendicitis, this trend toward inferior operative time was confirmed without reaching statistical significance (2D = 60min, 3D = 49.5min, p = 0.082 95% CI). No intra-operative complications were observed in either group. The conversion rate was 5.6% (4 patients) in the 2D group and 4.6% (3 patients) in 3D group. The utilization of 3D laparoscopy was associated with reduction in operative time without influencing other parameters, in particular without altering the safety profile of the procedure.

Comparison of short-term surgical outcome between 3D and 2D laparoscopy surgery for gastrointestinal cancer: a systematic review and meta-analysis

Three-dimensional (3D) laparoscopic surgery is becoming more popular with the development of laparoscopic devices. The objective of this study was to explore whether the 3D imaging system could improve surgical outcomes of laparoscopic surgery for gastrointestinal cancer compared with the 2D imaging system. Systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Surgical quality, postoperative complications, and postoperative recovery between 3D and 2D laparoscopic surgery groups were compared using a fixed or random effect model. A total of 12 studies involving 1456 patients (3D group 683 patients and 2D group 773 patients) were included in this meta-analysis. The results indicated that mean operation time was significantly shorter in 3D group than in 2D group (WMD, - 9.08; 95% CI, - 14.77, - 3.40; P = 0.002; I2= 70.3%), especially for gastric cancer patients (WMD, - 14.61; 95% CI, - 26.00, - 3.23, P = 0.012; I2= 74.1%). In addition, 3D laparoscopic surgery for gastric cancer had an advantage than 2D group in reducing the amount of intraoperative blood loss (WMD, - 13.60, 95% CI, - 21.48, - 5.72; P = 0.001; I2= 0%). The number of retrieved lymph nodes in 3D group was not significantly different from that in 2D group, regardless of laparoscopic gastrectomy (WMD, 1.10; 95% CI, - 0.67, 2.88; P = 0.222; I2= 18.8%) and laparoscopic colorectal surgery (WMD, 0.55, 95% CI; - 1.99, 3.09; P = 0.671; I2= 76.9%). In addition, there was no significant difference between 3D and 2D laparoscopic surgery for postoperative complications and postoperative recovery. Main advantages of 3D laparoscopic gastrectomy for gastric cancer were that it could shorten the operation time and reduce the amount of intraoperative blood loss. However, 3D laparoscopic surgery had no obvious advantage over 2D laparoscopic surgery for colorectal cancer patients.

Application of Laparoscopic Radical Cystectomy and Urinary Diversion based on 3D Technique

The 3D laparoscopic surgery overcomes the lack of depth of field in traditional laparoscopic images, and maximizes the true field of view, which provides great convenience for the development and improvement of this surgical technique. This investigation mainly explored the application of 3D laparoscopy in radical cystectomy and urinary diversion. The clinical data of 7 patients undergoing 3D laparoscopic total cystectomy and urinary diversion were retrospectively analyzed. The primary disease and surgical methods were analyzed. The success rate of 33 cases was 100 %. All patients underwent surgery without any additional incision. There was no open surgery and no perioperative death. The surgical margins were negative. The above patients were followed up for 8-12 months, and no tumor recurrence or metastasis was observed. The 3D laparoscopy restored the true anatomical level and effectively shortened the operation time. The system has the advantages of accurate operation, easy suturing and fewer complications, which reduces radical cystectomy and urinary diversion.

A case report of Insulinoma Pancreas in an 80 old lady with long standing history: managed by 3 -D Laparoscopic resection

Introduction: Insulinomas are a rare group of neuroendocrine tumors. Ninety percent are benign and most are solitary. They can have varied presentations and long-standing history of symptoms. Mostly people are affected in fourth to sixth decades of life. Insulinomas can have association with multiple endocrine neoplasia type 1 (MEN) however typically they are sporadic. Most are solitary and benign. Most common presentation is symptomatic hypoglycemia. After investigations, surgery is the treatment of choice and can offer cure. Laparoscopic surgery can offer all the benefits of minimally invasive surgery and equal oncological outcomes in high volume and dedicated centers. 3D laparoscopy further improves outcomes. Case Presentation: This case presentation is about an 80-year-old female who presented with long standing symptoms. After biochemical and radiological investigation, she was treated with 3-D laparoscopic distal pancreatectomy. Histopathology was consistent with insulinoma and she had resolution of symptoms. Conclusion: Insulinoma is a rare tumor and proper management is multidisciplinary. Proper management leads to rapid cure and resolution of the symptoms.

3D laparoscopic common bile duct exploration is safe and feasible

Introduction: 10-15% of patients with gallstones have common bile duct stones. Pre-operative endoscopic retrograde cholangiopancreaticography (ERCP), followed by laparoscopic cholecystectomy (LC) is the common treatment approach. However, recent studies showed that one stage laparoscopic common bile duct exploration (LCBDE) is also feasible though more technically demanding. Three-dimensional (3D) laparoscopy enhances depth perception, facilitates intra-corporeal suturing and is reported to reduce learning curve in laparoscopic surgery. There is no report of application of 3D technology to LCBDE. We report first case series of 3D LCBDE. Materials and Methods: We describe a case series of first 13 consecutive 3D LCBDE. Magnetic resonance cholangiopancreatography (MRCP) is liberally done for patients with deranged liver function test (LFT) and ERCP is reserved only for therapeutic intentions. CBD explorations are done through choledochotomy with 5mm choledochoscope and primarily repaired with absorbable suture without a stent. Clinical profile of patients, intraoperative details and outcomes were reported. Results: Mean age of patients was 70.6 (range 44 – 91) years. 7 patients (53.8%) were male. The indications for surgery were choledocholithasis 69.2% (n=9), cholangitis 15.4% (n=2) and gallstone pancreatitis 15.4% (n=2). More than half of the patients (53.1%, n=7) had pre-operative ERCP. 23% (n=3) had pre-operative biliary stent. The median American Society of Anaesthesiology (ASA) score was 2 (range 2-3) and the commonest comorbidity was hypertension (n=9, 69%). Pre-operative MRCP was done in majority of patients. (n=9,69%) and mean diameter of CBD was 14.6 mm (range 7-30). Median operative time was 125 (range 80 -265) minutes. 69% (n=9) had intra-operative drain inserted and this was removed at a median of 3 (range 3-4) days. There was no open conversion, bile leak and post-operative LFT were normal at one month. There was no mortality. Conclusion: 3D surgery provides binocular vision with depth perception which facilitates intra-corporeal suturing. 3D LCBDE is safe and feasible.

THE FIRST RESULTS OF LAPAROSCOPIC INTRAPERITONEAL ALLOPLASTY OF UMBILICAL AND POSTOPERATIVE VENTRAL HERNIAS WITH CLOSURE OF THE HERNIAL DEFECT USING 3D LAPAROSCOPY

Abstract. The aim of the study was to analyze the first results of laparoscopic alloplasty of the umbilical and postoperative ventral hernias with suturing the hernial defect using 3D laparoscopy. During the period from September 2018 to April 2019, we performed 12 intraperitoneal alloplastic umbilical and postoperative hernias of medium and large sizes. The main group consisted of 7 patients who underwent intraperitoneal alloplasty with closure of the hernial defect and sac. 3D laparoscopy was used in some patients, (Epic HD system, Richard Wolf). The control group consisted of 5 patients who underwent intraperitoneal alloplasty without suturing the hernial defect and sac.
 Seromes in the main group were in 3 cases, the average volume was 2 ml (from 0.5 to 3 ml), in the control group seromes were also in 3 cases, the average volume was 2.8 ml (from 1 to 5.5 ml). The immediate results, tracked from 1 to 6 months, showed no recurrence in both groups.

Can 3D Laparoscopy Improve Surgical Performances in Surgeons in Training?

Can 3D Laparoscopy Improve Surgical Performances in Surgeons in Training?

P69 INTRAOPERATIVE ENDOSCOPY IS OF A GREAT IMPORTANCE IN COMPLEX REVISIONAL UPPER GI SURGERY. CASE PRESENTATION OF RECURRENT ACHALASIA PREVIOUSLY TREATED WITH 3 LAPAROSCOPIC HELLERS CARDIOMYOTOMIES.

Abstract Aim To demonstrate the ability to perform increasingly complex revisional surgery utilising minimally invasive techniques and synchronous endoscopy for recurrent achalasia. Background & Methods We present a case of recurrent achalasia previously treated with 3 laparoscopic Hellers cardiomyotomies. Traditionally such a case would be considered for either open revisional surgery or oesophagectomy. In this case a fourth laparoscopic Hellers cardiomyotomy was succesfully performed using 3D laparoscopy combined with synchronous intraoperative endoscopy. The 3D video footage we present demonstrates the added safety provided by depth perception and high resolution imaging in revisional laparoscopic surgery. Synchronous endoscopy confirms altered anatomy, pathology and luminal change from extraluminal interventions resulting in prompt recognition of LES and subsequent efficient gastric myotomy. Results After a laborious adhesiolysis using the advantages of 3D imaging system we faced difficulties recognizing the exact LES location, in order to proceed with the gastric myotomy. In our opinion this could be the reason for previous treatment failures. At this point the use of synchronous flexible endoscopy enabled the recognition of cardia, so we could safely and efficiently complete a fourth laparoscopic Hellers cardiomyotomy including repair of a distal oesophageal diverticulum and a substantially lengthened gastric myotomy. This resulted in a substantial improvement in dysphagia symptoms with the patient resuming consumption of liquid and solid food as well. Conclusion Early adoption of technological advancements facilitates organ preserving revisional surgery and the avoidance of significant patient morbidity. These techniques radically increase the safety profile of minimally invasive surgery by facilitating anatomic recognition and provisioning for tailored intervention.

P182 3D TECHNOLOGY IN MINIMALLY INVASIVE UPPER GI SURGERY: COMPARISON BETWEEN DIFFERENT SYSTEMS

Abstract Aim Three-dimensional laparoscopy improves the depth of perception during minimally invasive surgery, leading to better visibility and more precise dissection, and providing better clinical and surgical outcomes in complex surgical procedures. The aim of this study was to compare the pros and cons of the 3D technological systems available in our Unit for UGI surgery. Background & Methods In our Unit, we have two different 3D systems for abdominal and thoracic surgery. B Braun has the EinsteinVision 3D system with 0 and 30 degree fixed camera. Olympus produces an Endoeye Flex with an articulating tip 0 degree 3D camera as well as an Endoeye 3D 0 and 30 degree rotating camera. Advantages and disadvantages of the different 3D systems were evaluated on the basis of the experience of our senior surgeons performing routinely 3D operations. Results All surgeons agreed of the superiority of 3D vision compared to conventional 2D laparoscopy or thoracoscopy. The B Braun system is not available in an integrated operating theatre system and does not allow image rotation, but provides a full HD sharp resolution and has the advantage of a reusable camera with single use warming cover which could be used for unlimited procedures every day. The Olympus Endoeye Flex does not provide HD resolution and can be more difficult to manoeuvre, but has the advantage of the articulating tip. The Olympus Endoeye 30 degree rotating camera has a better HD resolution and the advantage of image rotation while maintaining the horizon. Conclusion Technology beyond 3D laparoscopic system has been evolving rapidly. Different products have their own strengths and weaknesses, and surgeons should be familiar with the system used.

Three-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study

BackgroundThree-dimensional (3D) laparoscopy improves technical efficacy in laboratory environment, but evidence for clinical benefit is lacking. The aim of this study was to determine whether the 3D laparoscopy is beneficial in transabdominal preperitoneal laparoscopic inguinal hernia repair (TAPP).MethodIn this prospective, single-blinded, single-center, superior randomized trial, patients scheduled for TAPP were randomly allocated to either 3D or two-dimensional (2D) TAPP laparoscopic approaches. Patients were excluded if secondary operation was planned, the risk of conversion was high, or the surgeon had less than five previous 3D laparoscopic procedures. Patients were operated on by 13 residents and 3 attendings. The primary endpoint was operation time. The study was registered in ClinicalTrials.gov (NCT02367573).ResultsTotal 278 patients were randomized between 5th February 2015 and 23rd October 2017. Median operation time was shorter in the 3D group (56.0 min vs. 68.0 min, p < 0.001). 10 (8%) patients in 3D group and 6 (5%) patients in 2D group had clinically significant complications (Clavien–Dindo 2 or higher) (p = 0.440). Rate of hernia recurrence was similar between groups at 1-year follow-up. In the subgroup analyses, operation time was shorter in 3D laparoscopy among attendings, residents, female surgeons, surgeons with perfect stereovision, surgeons with > 50 3D laparoscopic procedures, surgeons with any experience in TAPP, patients with body mass indices < 30, and bilateral inguinal hernia repairs.Conclusion3D laparoscopy is beneficial and shortens operation time but does not affect safety or long-term outcomes of TAPP.

Diagnostic and prognostic potential of the use of ultrasound and three-dimensional endo-visualization in women with pelvic varicose veins

Aim. To study the diagnostic and prognostic potential of the complex use of ultrasound and 3D laparoscopy in women with pelvic varicose veins (PVV). Outcomes and methods. The study included 100 women who were divided into two groups: the main group (39 patients with various severity PVV) and the control group (61 women with no venous system disorders). All patients had a complete clinical examination with the selection of pairs that had the most significant factors for the disease prognosis: average age over 35 years, history of varicose veins, pain in the lower abdomen, dysmenorrhea and dyspareunia. Examination of the small pelvis venous system included duplex angioscanning and retrograde endoscopic functional test controlled by the three-dimensional image. Multivariate analysis (logistic regression) was used to identify normative phlebological parameters. Results. Predictors of early PVV are the following rations: Vmax in the cava-ovarian segment / Vmax in the right ovary portal ≥ 8.3 and Vmax in the reno-ovarian segment /Vmax in the left ovarian portal ≥ 8. The severity of PVV is determined by a progression of alterations in hemodynamic parameters in the main ovarian veins and a spreading venous congestion in the small pelvis plexuses. Conclusions. Criteria of small pelvis phlebohemodynamics make it possible to predict a development of PVV and a severity of the pathological process. Ovarian varicose veins are characteristic of early PVV and venous plethora of all pelvis venous plexuses is characteristic of late PVV.

3 D Laparoscopy: A Review

Background: Restricted depth perception in laparoscopy with two-dimensional imaging has been reported to be a major disadvantage of minimally invasive procedures. Three-dimensional imaging have been available for almost 2 years and are slowly being integrated into endoscopic surgery. Methods: A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. Some review articles were also searched. 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: Many articles were screened for eligibility, and RCTs were included in the review. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 16 trials. Seven out of 11 trials (71%) showed a reduction in performance time, and 10 out of 16 (63%) showed a significant reduction in error when using 3D compared to 2D. Conclusions: This study aims to show that 3D technology in laparoscopy promises to be an indispensable tool. The feasibility and safety of this surgical innovation has been shown. 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.

Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial

BackgroundLaparoscopic surgery has well-established benefits for patients; however, laparoscopic procedures have a long and difficult learning curve, in large part due to the lack of stereoscopic depth perception. Developments in high-definition and stereoscopic imaging have attempted to overcome this. Three-dimensional high-definition (3D HD) systems are thought to improve operating times compared to two-dimensional high-definition systems. However their performance against new, ultra-high-definition (‘4K’) systems is not known.MethodsPatients undergoing laparoscopic cholecystectomy were randomised to 3D HD or 4K laparoscopy. Operative videos were recorded, and the time from gallbladder exposure to separation from the liver (minus on table cholangiogram) was calculated. Blinded video assessment was performed to calculate intraoperative error scores.ResultsOne hundred and twenty patients were randomised, of which 109 were analysed (3D HD n = 54; 4K n = 55). No reduction in operative time was detected with 3D HD compared to 4K laparoscopy (median [IQR]; 23.41 min [17.00–37.98] vs 20.90 min [17.67–33.03]; p = 0.91); nor was there any decrease observed in error scores (60 [56–62] vs 58 [56–60]; p = 0.27), complications or reattendance. Stone spillage occurred more frequently with 3D HD, but there were no other differences in individual error rates. Gallbladder grade and operating surgeon had significant effects on time to complete the operation. Gallbladder grade also had a significant effect on the error score.ConclusionsA 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system.

3D laparoscopy does not reduce operative duration or errors in day-case laparoscopic cholecystectomy: a randomised controlled trial

BackgroundContemporary 3D platforms have overcome past deficiencies. Available trainee and laboratorystudies suggest stereoscopic imaging improves performance but there is little clinical data or studies assessing specialists. We aimed to determine whether stereoscopic (3D) laparoscopic systems reduce operative time and number of intraoperative errors during specialist-performed laparoscopic cholecystectomy (LC).MethodsA parallel arm (1:1) randomised controlled trial comparing 2D and 3D passive-polarised laparoscopic systems in day-case LC using was performed. Eleven consultant surgeons that had each performed > 200 LC (including > 10 3D LC) participated. Cases were video recorded and a four-point difficulty grade applied. The primary outcome was overall operative time. Subtask time and the number of intraoperative consequential errors as identified by two blinded assessors using a hierarchical task analysis and the observational clinical human reliability analysis technique formed secondary endpoints.Results112 patients were randomised. There was no difference in operative time between 2D and 3D LC (23:14 min (± 10:52) vs. 20:17 (± 9:10), absolute difference − 14.6%, p = 0.148) although 3D surgery was significantly quicker in difficulty grade 3 and 4 cases (30:23 min (± 9:24), vs. 18:02 (± 7:56), p < 0.001). No differences in overall error count was seen (total 47, median 1, range 0–4 vs. 45, 1, 0–3, p = 0.62) although there were significantly fewer 3D gallbladder perforations (15 vs. 6, p = 0.034).Conclusion3D laparoscopy did not reduce overall operative time or error frequency in laparoscopic cholecystectomies performed by specialist surgeons. 3D reduced Calot’s dissection time and operative time in complex cases as well as the incidence of iatrogenic gallbladder perforation (NCT01930344).

Technology innovation in minimally invasive surgery for gastrointestinal and colorectal surgery

Minimally invasive surgery is worldwide adopted. The technology of minimally invasive surgery plays an important role in improvement of diagnosis and treatment of diseases. In recent years, new technology of minimally invasive surgery, such as 4K laparoscopy, glasses-free 3D laparoscopy, virtual reality with 5G technology, and fluorescence imaging guided laparoscopic surgery improve the procedure, standardization and training of laparoscopic surgery for gastrointestinal and colorectal diseases. The authors hope that with the great improvement of economy technology, we can also lead the innovation of technology and standardization of technique in minimally invasive surgery in near future. Key words: Gastrointestinal and colorectal surgery; Minimally invasive surgery; Surgical procedures, operative; Innovation

Clinical application of 3D printing combined with 3D laparoscopy in partial nephron-sparing surgery for partial endogenous renal cell carcinoma

Objective To investigate the clinical feasibility and effectiveness of 3-D printing (3DP) combined with 3-D laparoscopic nephron-sparing surgery (LNSS) for partial endogenous renal cell carcinoma. Methods A retrospective analysis was made of the clinical data of 79 patients with partial endogenous renal cell carcinoma who were admitted to our department from July 2015 to October 2018. There were 46 males and 33 females.Their average age was (50.9±7.9) years old, ranged from 33 to 68 years old. Tumor stages were T1aN0M0 in 53 cases and T1bN0M0 in 26 cases. The preoperative serum creatinine ranged from 40 to 107 μmol/L, with an average of (72.4±14.2)μmol/L. The preoperative GFR ranged from 19 to 54 ml/min, with an average of (40.2±6.2)ml/min. Thirty-four patients underwent 2-D laparoscopic nephron-sparing surgery (2DLNSS) based on preoperative enhanced CT scans. Forty-five patients underwent 3-D printing (3DP) based on three-dimensional reconstruction of renal CT scans. Seventeen patients underwent 2-D laparoscopic nephron-sparing surgery guided by 3-D printing model(3DP-2DLNSS), and 28 patients underwent 3-D laparoscopic nephron-sparing surgery guided by 3-D printing (3DP-3DLNSS). Serum creatinine levels ranged from 42 to 122 μmol/L with an average of (86.3±14.8)μmol/L, and creatinine levels ranged from 8 to 66 μmol/L with an average of (19.1±14.1)μmol/L. Six months after operation, the GFR of the kidney was 9-36 ml/min with an average of (21.4±6.4)ml/min, and the fluctuation range was 6-40 ml/min with an average of (19.2±8.8) ml/min. There was no statistical difference in the incidence of complications and pathological types after operation. Results There was no statistical difference in general data of preoperative patients. In intraoperative and post-operative statistics, the time of exploring renal artery was shorter than that of 2DLNSS (33.7±7.5) min in 3DP-2DLNSS (28.3±8.2, P=0.015) min and 3DP-3DLNSS(27.8±6.5, P=0.002)min. In tumor detection time, 3DP-2DLNSS was shorter than 2DLNSS group (41.2±6.6 vs.46.5±6.9 min, P=0.012), and 3DP-3DLNSS was shorter than 3DP-2DLNSS (35.4±7.3 vs. 41.2±6.6 min, P=0.009). In warm ischemia time, 3DP-2DLNSS min was shorter than 2DLNSS (23.5±9.7 vs. 33.9±7.5 min P<0.001), and 3DP-3DLNSS was shorter than 3DP-2DLNSS (18.3±4.6 vs. 23.5±9.7, P=0.023). In surgical time, 3DP-2DLNSS (115.7±23.0) min and 3DP-3DLNSS (103.3±22.8) min were shorter than 2DLNSS (132.4±28.9) min (P=0.031, P<0.001). In intraoperative bleeding volume, 3DP-3DLNSS was less than 2DLNSS (117.9±17.9 vs. 130.6±16.8, P=0.009)ml. Fasting for 1 to 4 days after operation, with an average of (1.7±0.8) days. The indwelling catheterization ranged from 1 to 8 days after operation, with an average of (3.9±1.3)days. Negative pressure drainage was removed 2-9 days after operation, with an average of (4.9±1.4)days. And the hospitalization 5-11 days after operation, with an average of (7.3±1.5)days. Conclusions Preoperative 3D printing combined with intraoperative 3D laparoscopic nephron sparing surgery for partial endogenous renal tumors is safe and effective, which is superior to the previous CT scan alone and intraoperative 2D laparoscopic treatment. Key words: Partial endogenous renal cell carcinoma; 3-D printing; 3-D laparoscopy; Nephron-sparing surgery