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Feng X, Morandi A, Imvised T, Ure B, Kuebler JF, Lacher M. Three-Dimensional Versus Two-Dimensional Imaging in Adult Versus Pediatric Laparoscopy: A Simulator Box Study. J Laparoendosc Adv Surg Tech A 2016; 25:1051-6. [PMID: 26673534 DOI: 10.1089/lap.2015.0085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM Three-dimensional (3D) imaging has been shown to enhance depth perception and facilitate operations in training box studies and in adult laparoscopy. However, there are no data on 3D vision in small working spaces, which are common pediatric surgery. Therefore, this study examined the impact of monoscopic versus stereoscopic visualization in large versus small working spaces in individuals with varying surgical expertise. MATERIALS AND METHODS Twenty-four individuals with varying surgical expertise (experts, surgical residents, and surgical novices) were involved in the study. Participants were asked to perform four tasks in large (24- × 30- × 50-cm) and small (9- × 11- × 18-cm) training boxes, using two-dimensional and 3D imaging. Sixteen standardized procedures were performed by each participant. Primary outcome measure was performance time. Secondary outcome parameters included the number of errors and subjective depth perception. RESULTS Surgical novices showed a shorter performance time and lesser total number of errors in large and small training boxes using 3D imaging. Residents achieved a significantly shorter performance time in the large and lesser number of errors in the small box. With 3D vision experts performed laparoscopic suturing in the small box and target touching in both boxes significantly faster. The overall performance time and total number of errors of experts were not different in the two boxes. Subjective depth perception with 3D vision in the small box in all groups and in the small box in surgical novices was significantly better. CONCLUSIONS We identified several advantages of 3D vision in individuals with varying surgical expertise. However, the benefits were rather experienced by surgical novices and residents than by experts. Differences in performance time and number of errors were similar in the large and small simulator boxes.
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Affiliation(s)
- Xiaoyan Feng
- 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany
| | - Anna Morandi
- 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany
| | - Tawan Imvised
- 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany
| | - Benno Ure
- 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany
| | - Joachim F Kuebler
- 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany
| | - Martin Lacher
- 1 Center of Pediatric Surgery, Hannover Medical School , Hannover, Germany
- 2 Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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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: 2.8] [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: 52] [Impact Index Per Article: 6.5] [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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Becker S, De Wilde RL. Complications in gynecological minimal-access oncosurgery. Best Pract Res Clin Obstet Gynaecol 2016; 35:63-70. [PMID: 27066936 DOI: 10.1016/j.bpobgyn.2016.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/20/2022]
Abstract
Complications are the limiting factors of all surgeries. More than performing the actual surgery, learning how to avoid complications before, during, and after surgery is the most important task of every surgeon. Severe complications can lead to patient death. Complications such as ureterovaginal fistulas, resulting from <2 s of inattentive preparation, can lead to years of hardship, suffering, accusation, and litigation. Excellent surgery is about performing the right surgery for the right patient without any complications. Minimally invasive surgery in complex cases is technically challenging. This article details the major causes of complications in laparoscopy for the gynecologic cancer patient and present strategies for prevention, early detection, and intra- and postoperative management.
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Affiliation(s)
- Sven Becker
- Frankfurt University Women's Hospital, Frankfurt, Germany.
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Short-Term Outcome of Three-Dimensional Versus Two-Dimensional Video-Assisted Thoracic Surgery for Benign Pulmonary Diseases. Ann Thorac Surg 2016; 101:1297-302. [DOI: 10.1016/j.athoracsur.2015.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/25/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023]
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Tang FJ, Qi L, Jiang HC, Tong SY, Li Y. Comparison of the clinical effectiveness of 3D and 2D imaging systems for laparoscopic radical cystectomy with pelvic lymph node dissection. J Int Med Res 2016; 44:613-9. [PMID: 26975511 PMCID: PMC5536712 DOI: 10.1177/0300060515621445] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/13/2015] [Indexed: 11/21/2022] Open
Abstract
Objective To compare the clinical effectiveness of three-dimensional (3D) and two-dimensional (2D) laparoscopic imaging systems for radical cystectomy (RC) with pelvic lymph node dissection. Methods This was a retrospective analysis of data collected from all patients who underwent RC with pelvic lymph node dissection between January 2013 and May 2014, performed by a single surgeon in our clinic. Demographic characteristics and operative data from the procedure were collected and compared. Results Data were available from 42 patients (mean age 63 ± 6.7 years) of whom 18 were operated on using a 3D imaging laparoscope (Group 3D) and 24 were operated on using a conventional 2D laparoscope (Group 2D). There were no statistically significant differences in patient characteristics between the two groups (P > 0.05). There was no difference between groups in the mean (±SD) number of lymph nodes retrieved from each patient (13.2 ± 4.6 and 12.5 ± 4.3, for the 3D and 2D groups respectively), or in blood loss. PLND duration and total operative time were statistically significantly lower in Group 3D than in group 2D. There were no statistically significant between-group differences in postoperative hospital stay or total cost of the procedures. Serious postoperative complications occurred in one patient (5.6%) in group 3D, and four patients (16.7%) in group 2D (P = 0.075). Conclusions With the assistance of 3D stereoscopic imaging, surgeons may be able to reduce both the duration of lymph node dissection and overall operative time during laparoscopic RC with pelvic lymph node dissection, without increasing postoperative hospital stay or total cost.
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Affiliation(s)
- Feng Jie Tang
- Department of Urology, Xiang Ya Hospital, Central South University, Changsha, China
| | - Lin Qi
- Department of Urology, Xiang Ya Hospital, Central South University, Changsha, China
| | - Hui Chuan Jiang
- Department of Urology, Xiang Ya Hospital, Central South University, Changsha, China
| | - Shi Yu Tong
- Department of Urology, Xiang Ya Hospital, Central South University, Changsha, China
| | - Yuan Li
- Department of Urology, Xiang Ya Hospital, Central South University, Changsha, China
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Egi H, Hattori M, Suzuki T, Sawada H, Kurita Y, Ohdan H. The usefulness of 3-dimensional endoscope systems in endoscopic surgery. Surg Endosc 2016; 30:4562-8. [PMID: 26895893 DOI: 10.1007/s00464-016-4793-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The image quality and performance of 3-dimensional video image systems has improved along with improvements in technology. However, objective evaluation on the usefulness of 3-dimensional video image systems is insufficient. Therefore, we decided to investigate the usefulness of 3-dimensional video image systems using the objective endoscopic surgery technology evaluating apparatus that we have developed, the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD). METHODS The participants were 28 student volunteers enrolled in Hiroshima University (17 men and 11 women, age: median 22.5, range 20-25), with no one having experienced endoscopic surgery training. Testing was carried out by dividing the subjects into two groups to initially carry out HUESAD with 2-dimensional video imaging (N = 14) and with 3-dimensional video imaging (N = 14). Questionnaires were carried out along with the investigation regarding both 2-dimensional and 3-dimensional video imaging. The task was carried out for approximately 15 min regarding both 2-dimensional and 3-dimensional video imaging. Lastly, the Mental Rotation Test, which is a standard space perception ability test, was used to evaluate the space perception ability. RESULTS No difference was observed in the nauseous and uncomfortable feeling of practitioners between the two groups. Regarding smoothness, no difference was observed between 2-dimensional and 3-dimensional video imaging (p = 0.8665). Deviation (space perception ability) and approaching time (accuracy) were significantly lower with 3-dimensional video imaging compared to 2-dimensional video imaging. Moreover, the approaching time (accuracy) significantly improved in 3-dimensional video imaging compared to 2-dimensional video imaging in the group with low space perception ability (p = 0.0085). CONCLUSION Objective evaluation using HUESAD and subjective evaluation by questionnaire revealed that endoscopic surgery techniques significantly improved in 3-dimensional video imaging compared to 2-dimensional video imaging. Moreover, it is believed that this effect is more effective in people with low space perception ability and beginner students.
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Affiliation(s)
- Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Minoru Hattori
- Advanced Medical Skills Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahisa Suzuki
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Sawada
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuichi Kurita
- Department of Artificial Complex Systems Engineering, Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Leite M, Carvalho AF, Costa P, Pereira R, Moreira A, Rodrigues N, Laureano S, Correia-Pinto J, Vilaça JL, Leão P. Assessment of Laparoscopic Skills Performance. Surg Innov 2016; 23:52-61. [DOI: 10.1177/1553350615585638] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction and Objectives. Laparoscopic surgery has undeniable advantages, such as reduced postoperative pain, smaller incisions, and faster recovery. However, to improve surgeons’ performance, ergonomic adaptations of the laparoscopic instruments and introduction of robotic technology are needed. The aim of this study was to ascertain the influence of a new hand-held robotic device for laparoscopy (HHRDL) and 3D vision on laparoscopic skills performance of 2 different groups, naïve and expert. Materials and Methods. Each participant performed 3 laparoscopic tasks—Peg transfer, Wire chaser, Knot—in 4 different ways. With random sequencing we assigned the execution order of the tasks based on the first type of visualization and laparoscopic instrument. Time to complete each laparoscopic task was recorded and analyzed with one-way analysis of variance. Results. Eleven experts and 15 naïve participants were included. Three-dimensional video helps the naïve group to get better performance in Peg transfer, Wire chaser 2 hands, and Knot; the new device improved the execution of all laparoscopic tasks ( P < .05). For expert group, the 3D video system benefited them in Peg transfer and Wire chaser 1 hand, and the robotic device in Peg transfer, Wire chaser 1 hand, and Wire chaser 2 hands ( P < .05). Conclusion. The HHRDL helps the execution of difficult laparoscopic tasks, such as Knot, in the naïve group. Three-dimensional vision makes the laparoscopic performance of the participants without laparoscopic experience easier, unlike those with experience in laparoscopic procedures.
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Affiliation(s)
- Mariana Leite
- ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana F. Carvalho
- ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- General Surgery, Hospital de Braga, Portugal
| | - Patrício Costa
- ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ricardo Pereira
- DIGARC, Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
| | - Antonio Moreira
- DIGARC, Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
| | - Nuno Rodrigues
- DIGARC, Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
| | - Sara Laureano
- ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - João L. Vilaça
- ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Leão
- ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- General Surgery, Hospital de Braga, Portugal
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Yang C, Mo L, Ma Y, Peng G, Ren Y, Wang W, Liu Y, He J. A comparative analysis of lung cancer patients treated with lobectomy via three-dimensional video-assisted thoracoscopic surgery versus two-dimensional resection. J Thorac Dis 2015; 7:1798-805. [PMID: 26623103 DOI: 10.3978/j.issn.2072-1439.2015.10.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Three-dimensional (3D) vision systems are now available for thoracic surgery. It is unclear whether 3D video-assisted thoracic surgery (VATS) is superior to 2D VATS systems. This study aimed to compare the operative and perioperative data between 2D and 3D VATS lobectomy (VTL) and to identify the actual role of 3D VTL in thoracic surgery. METHODS A two-institutional comparative study was conducted from November 2013 to November 2014 at Liaoning Cancer Hospital & Institute and the First Affiliated Hospital of Guangzhou Medical University, China, of 300 patients with resectable non-small cell lung cancer (NSCLC). Patients were assigned to receive either the 3D VATS (n=150) or 2D VATS (n=150) lobectomy. The operative and perioperative data between 2D VATS and 3D VATS were compared. RESULTS Although there was no significant difference between the two groups regarding the incidence of each single complication, a significantly less operative time was found in the 3D VATS group (145 min) than in the 2D VATS group (176 min) (P=0.006). Postoperative mortality rates in 3D VATS and 2D VATS groups were both 0%.No significant difference was found between groups for estimated blood loss (P=0.893), chest drainage tube placement time (P=0.397), length of hospital stay (P=0.199), number of lymph nodes resected (P=0.397), postoperative complications (P=0.882) and cost of care (P=0.913). CONCLUSIONS Early results of this study demonstrate that the 3D VATS lobectomy procedure can be performed with less operative time. 3D VATS and 2D VATS lobectomy are both safe procedures in first-line surgical treatment of NSCLC.
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Affiliation(s)
- Chengliang Yang
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lili Mo
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yegang Ma
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Guilin Peng
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yi Ren
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yongyu Liu
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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Cicione A, Autorino R, Laguna MP, De Sio M, Micali S, Turna B, Sanchez-Salas R, Quattrone C, Dias E, Mota P, Bianchi G, Damiano R, Rassweiler J, Lima E. Three-dimensional Technology Facilitates Surgical Performance of Novice Laparoscopy Surgeons: A Quantitative Assessment on a Porcine Kidney Model. Urology 2015; 85:1252-6. [PMID: 26099869 DOI: 10.1016/j.urology.2015.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether the use of 3-dimensional (3D) imaging translates into a better surgical performance of naïve urologic laparoscopic surgeons during pyeloplasty (PY) and partial nephrectomy (PN) procedures. MATERIALS AND METHODS Eighteen surgeons without any previous laparoscopic experience were randomly assigned to perform PY and PN in a porcine model using initially 2-dimensional (2D) and 3D laparoscopy. A surgical performance score was rated by an "expert" tutor through a modified 5-item global rating scale contemplating operative field view, bimanual dexterity, efficiency, tissue handling, and autonomy. Overall surgical time, complications, subjective perception of participating surgeons, and inconveniences related to the 3D vision were recorded. RESULTS No difference in terms if operative time was found between 2D or 3D laparoscopy for both the PY (P = .51) and the PN (P = .28) procedures. A better rate in terms of surgical performance score was noted by the tutors when the study participants were using 3D vs 2D, for both PY (3.6 [0.8] vs 3.0 [0.4]; P = .034) and PN (3.6 [0.51] vs 3.15 [0.63]; P = .001). No complications occurred in any of the procedures. Most (77.2%) of the participating naïve laparoscopic surgeons had the perception that 3D laparoscopy was overall easier than 2D. Headache (18.1%), nausea (18.1%), and visual disturbance (18.1%) were the most common issues reported by the surgeons during 3D procedures. CONCLUSION Despite the absence of translation in a shorter operative time, the use of 3D technology seems to facilitate the surgical performance of naïve surgeons during laparoscopic kidney procedures on a porcine model.
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Affiliation(s)
- Antonio Cicione
- Department of Urology, Magna Graecia University, Catanzaro, Italy
| | - Riccardo Autorino
- Department of Urology, University Hospitals, Cleveland, OH; Department of Urology, Second University, Napoli, Italy.
| | | | - Marco De Sio
- Department of Urology, Second University, Napoli, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Burak Turna
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | | | | | - Emanuel Dias
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Paulo Mota
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Giampoalo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University, Catanzaro, Italy
| | - Jens Rassweiler
- Department of Urology, SLK-Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany
| | - Estevao Lima
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
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Romero-Loera S, Cárdenas-Lailson LE, de la Concha-Bermejillo F, Crisanto-Campos BA, Valenzuela-Salazar C, Moreno-Portillo M. [Skills comparison using a 2D vs. 3D laparoscopic simulator]. CIR CIR 2015; 84:37-44. [PMID: 26259739 DOI: 10.1016/j.circir.2015.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 06/02/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND The development and application of 3D images in laparoscopic surgery has brought the benefit of in-depth perception that traditional laparoscopic surgery lacked. Previous studies in surgical populations have demonstrated the advantages of 3D technology. To limit bias of the previous experiences of participants, this study was performed in a population without any experience in this area. MATERIAL AND METHODS An experimental, open, cross-sectional, comparative study between surgical skills achievements using 2D and a 3D laparoscopy equipment, using each subject as their own control. Six skills were evaluated in 2D and 3D modalities. RESULTS Of the 40 participants included, 20 began the skills in the 2D modality and then performed them in 3D, and the other 20 began in 3D. Of the 118 skills evaluated there was a time improvement in 72% in the 3D group compared to 37% in the 2D modality (P=.000). The accomplishment percentage using the 3D laparoscopy was greater for both groups. There was a statistically significant difference in the better time for the 3D performed tasks. Just over half (52.5%) of participants preferred 3D laparoscopy, 15% preferred 2D, and 32.5% had no preferences. DISCUSSION As other studies have demonstrated, there was improvement in the overall performance using the 3D laparoscope. Bias was limited by using a population without surgical experience. CONCLUSIONS 3D laparoscopic surgical skills showed superior to 2D, with higher percentages of tasks completion, less time in performing them, and a shorter learning curve.
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Affiliation(s)
- Sujey Romero-Loera
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D. F., México.
| | | | | | | | - Carlos Valenzuela-Salazar
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D. F., México
| | - Mucio Moreno-Portillo
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D. F., México
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63
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Stereoscopic (3D) versus monoscopic (2D) laparoscopy: comparative study of performance using advanced HD optical systems in a surgical simulator model. World J Urol 2015; 34:471-7. [DOI: 10.1007/s00345-015-1660-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022] Open
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64
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Park YS, Oo AM, Son SY, Shin DJ, Jung DH, Ahn SH, Park DJ, Kim HH. Is a robotic system really better than the three-dimensional laparoscopic system in terms of suturing performance?: comparison among operators with different levels of experience. Surg Endosc 2015; 30:1485-90. [DOI: 10.1007/s00464-015-4357-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/16/2015] [Indexed: 01/11/2023]
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65
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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: 3.2] [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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66
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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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67
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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: 2.0] [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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68
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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: 160] [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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69
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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: 3.6] [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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70
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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: 3.4] [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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71
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Are structured curriculums for laparoscopic training useful? A review of current literature. Curr Opin Urol 2015; 25:163-7. [DOI: 10.1097/mou.0000000000000138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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72
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Two-Dimensional Versus Three-Dimensional Laparoscopy: Evaluation of Physicians' Performance and Preference Using a Pelvic Trainer. J Minim Invasive Gynecol 2015; 22:421-7. [DOI: 10.1016/j.jmig.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/09/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
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73
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Feng X, Morandi A, Boehne M, Imvised T, Ure BM, Ure Benno M, Kuebler JF, Lacher M. 3-Dimensional (3D) laparoscopy improves operating time in small spaces without impact on hemodynamics and psychomental stress parameters of the surgeon. Surg Endosc 2015; 29:1231-9. [PMID: 25673344 DOI: 10.1007/s00464-015-4083-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/14/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Three-dimensional (3D) imaging, a recent technical innovation in laparoscopic surgery, has been postulated to enhance depth perception and facilitate operations. However, it has never been evaluated in conditions where the focus is close to the optical system. Thus, it is unclear whether 3D cameras can improve laparoscopic surgical performance in neonates and infants. We tested 3D versus two-dimensional (2D) vision during laparoscopic surgery in rabbits, mimicking the size of a neonatal patient. MATERIALS AND METHODS Cadaver New Zealand white rabbits (mean weight 2,755 g) were operated by two surgeons experienced in 2D laparoscopic surgery and two surgical residents (with basic skills in 2D laparoscopy). All surgeons had never performed 3D laparoscopic surgery. Animals underwent six operations: Nissen fundoplication, small bowel anastomosis, and closure of a diaphragmatic defect using either 2D or 3D. Primary endpoint was cumulative operating time and operating time of each operation. Secondary endpoints included the hemodynamic response and psychomental stress level of the surgeons. Finally, subjective data on depth perception were assessed by questionnaires. RESULTS Cumulative operating time of all three types of operations was significantly shorter with 3D laparoscopy in experts (3D: 23.01 ± 5.65 min vs 2D: 29.51 ± 7.51 min, p < 0.01) and residents (3D: 27.95 ± 3.69 min vs 2D: 33.95 ± 6.21 min, p < 0.05). This effect could be shown for each operation in the expert group and the Nissen fundoplication in the resident group. There were no differences in the hemodynamic response as well as the psychomental stress level between 2D and 3D imaging. 3D provided better depth perception. CONCLUSION 3D laparoscopy in small spaces is associated with a significant shorter operating time. It induces no additional physical or psychomental stress in surgeons naive to 3D imaging. 3D may therefore facilitate minimal invasive surgery in neonates and infants.
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Affiliation(s)
- Xiaoyan Feng
- Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Wang D, Zhang B, Yuan X, Zhang X, Liu C. Preoperative planning and real-time assisted navigation by three-dimensional individual digital model in partial nephrectomy with three-dimensional laparoscopic system. Int J Comput Assist Radiol Surg 2015; 10:1461-8. [DOI: 10.1007/s11548-015-1148-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/31/2014] [Indexed: 11/24/2022]
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75
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An assessment of the new generation three-dimensional high definition laparoscopic vision system on surgical skills: a randomized prospective study. Surg Endosc 2014; 29:2305-13. [DOI: 10.1007/s00464-014-3949-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/14/2014] [Indexed: 11/26/2022]
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76
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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: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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77
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Autorino R, Cicione A, Rassweiler J, Lima E. Re: Willem M. Brinkman, Irene M. Tjiam, Barbara M.A. Schout, et al. Results of the European basic laparoscopic urological skills examination. Eur Urol 2014;65:490-6. Eur Urol 2013; 65:e38-9. [PMID: 24331153 DOI: 10.1016/j.eururo.2013.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Unit, Second University of Naples, Naples, Italy.
| | - Antonio Cicione
- Urology Unit, Magna Graecia University, Catanzaro, Italy; Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | - Jens Rassweiler
- Department of Urology, SLK Klinken Heilbronn, Heilbronn, Germany
| | - Estevao Lima
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
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