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Amiri R, Zwart MJW, Jones LR, Abu Hilal M, Beerlage HP, van Berge Henegouwen MI, Lameris WW, Bemelman WA, Besselink MG. Surgeon Preference and Clinical Outcome of 3D Vision Compared to 2D Vision in Laparoscopic Surgery: Systematic Review and Meta-Analysis of Randomized Trials. ANNALS OF SURGERY OPEN 2024; 5:e415. [PMID: 38911624 PMCID: PMC11191999 DOI: 10.1097/as9.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To assess the added value of 3-dimensional (3D) vision, including high definition (HD) technology, in laparoscopic surgery in terms of surgeon preference and clinical outcome. Background The use of 3D vision in laparoscopic surgery has been suggested to improve surgical performance. However, the added value of 3D vision remains unclear as a systematic review of randomized controlled trials (RCTs) comparing 3D vision including HD technology in laparoscopic surgery is currently lacking. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines with a literature search up to May 2023 using PubMed and Embase (PROSPERO, CRD42021290426). We included RCTs comparing 3D versus 2-dimensional (2D) vision in laparoscopic surgery. The primary outcome was operative time. Meta-analyses were performed using the random effects model to estimate the pooled effect size expressed in standard mean difference (SMD) with corresponding 95% confidence intervals (CIs). The level of evidence and quality was assessed according to the Cochrane risk of bias tool. Results Overall, 25 RCTs with 3003 patients were included. Operative time was reduced by 3D vision (-8.0%; SMD, -0.22; 95% CI, -0.37 to -0.06; P = 0.007; n = 3003; 24 studies; I 2 = 75%) compared to 2D vision. This benefit was mostly seen in bariatric surgery (-16.3%; 95% CI, -1.28 to -0.21; P = 0.006; 2 studies; n = 58; I 2 = 0%) and general surgery (-6.7%; 95% CI, -0.34 to -0.01; P = 0.036; 9 studies; n = 1056; I 2 = 41%). Blood loss was nonsignificantly reduced by 3D vision (SMD, -0.33; 95% CI, -0.68 to 0.017; P = 0.060; n = 1830; I 2 = 92%). No differences in the rates of morbidity (14.9% vs 13.5%, P = 0.644), mortality (0% vs 0%), conversion (0.8% vs 0.9%, P = 0.898), and hospital stay (9.6 vs 10.5 days, P = 0.078) were found between 3D and 2D vision. In 15 RCTs that reported on surgeon preference, 13 (87%) reported that the majority of surgeons favored 3D vision. Conclusions Across 25 RCTs, this systematic review and meta-analysis demonstrated shorter operative time with 3D vision in laparoscopic surgery, without differences in other outcomes. The majority of surgeons participating in the RCTs reported in favor of 3D vision.
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Affiliation(s)
- Rawin Amiri
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Maurice J. W. Zwart
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Leia R. Jones
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Harrie P. Beerlage
- Cancer Center Amsterdam, Netherlands
- Department of Urology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Mark I. van Berge Henegouwen
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Wytze W. Lameris
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Willem A. Bemelman
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Marc G. Besselink
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
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Rodrigues ACLF, Shojaeian F, Thanawiboonchai T, Zevallos A, Greer J, Adrales GL. 3D versus 2D laparoscopic distal gastrectomy in patients with gastric cancer: a systematic review and meta-analysis. Surg Endosc 2023; 37:7914-7922. [PMID: 37430123 DOI: 10.1007/s00464-023-10271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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 - 28.57 min, 95% CI - 50.70 to - 6.44, p = 0.011), intraoperative blood loss (WMD - 6.69 mL, 95% CI - 8.09 to - 5.29, p < 0.001), and postoperative hospital stay (WMD - 0.92 days, 95% CI - 1.43 to - 0.42, p < 0.001). There were no significant differences in time to first postoperative flatus (WMD - 0.22 days, 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. CONCLUSION Our study highlights the potential advantages of 3D laparoscopy in distal gastrectomy, including shorter operative time, postoperative hospital stay, and decreased intraoperative blood loss.
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Affiliation(s)
- Amanda Cyntia Lima Fonseca Rodrigues
- Department of Medicine, Positivo University, Curitiba, Brazil
- Department of Statistics and Biostatistics, Anhembi Morumbi University, Curitiba, Brazil
| | - Fatemeh Shojaeian
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA
| | - Theethawat Thanawiboonchai
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA
| | - Alba Zevallos
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
- Universidad Científica del Sur, Lima, Peru
| | - Jonathan Greer
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA
| | - Gina L Adrales
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA.
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Lin H, Cai Z, Xu Y, Guo Z, Wu H, Li Z. Short and Long-term Efficacy of 3-dimensional Laparoscopic-assisted D2 Radical Gastrectomy Under the Guidance of Membrane Anatomy for Locally Advanced Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2023; 33:339-346. [PMID: 37235723 DOI: 10.1097/sle.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/03/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND 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. PATIENTS AND METHODS 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. RESULTS 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 ± 48.75 mL and 74.29 ± 47.33 mL, 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). CONCLUSIONS 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.
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Affiliation(s)
- Huimei Lin
- School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhiming Cai
- School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Yanchang Xu
- School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, Fujian, China
- Institute of Minimally Invasive Surgery, Putian University, Putian, Fujian, China
| | - Zipei Guo
- School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Haiyan Wu
- Department of Pathology, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, Fujian, China
| | - Zhixiong Li
- School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, Fujian, China
- Institute of Minimally Invasive Surgery, Putian University, Putian, Fujian, China
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Wahba R, Urbanski A, Datta RR, Kleinert R, Bruno L, Zervakis A, Thomas MN. Operating room time savings in Germany- and UK-based hospitals with 3D- VS. 2D-imaging technology in laparoscopic surgery: Meta analysis and budget impact model - Health economic evaluation. Int J Surg 2022; 102:106643. [PMID: 35490950 DOI: 10.1016/j.ijsu.2022.106643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
AIMS Opportunity cost (OC) analysis is key when evaluating surgical techniques. Operating room (OR) time is one potential source of OC in laparoscopic surgery. This study quantifies differences in OR time between 3D- and 2D-imaging technology in laparoscopic surgery, translates these into OC and models the economic impact in real-world hospitals. METHODS First a systematically performed literature review and meta-analysis were conducted. Then, methods to translate OR time savings into OC were theorised and a budget impact model was created. After that, the potential time savings of real-world hospital case mixes were extrapolated. Finally, the opportunity costs of not using 3D-imaging in laparoscopic surgery were evaluated. RESULTS Average OR time saving per laparoscopic procedure was -19.4 min (-24.3; -14.5) (-14%) in favour of 3D. The Budget Impact Model demonstrated an economic impact of using 3D-laparoscopy instead of 2D laparoscopy, ranging from £183,045-£866,316 in the British and 73,049€-437,829€ in German hospitals, modelling a mixture of cost savings and performing additional procedures (earning additional revenue). CONCLUSION The OC analysis revealed significant economic benefits of introducing 3D-imaging technology in laparoscopic surgery, on the basis that average procedure time is reduced. Utilising the saved OR time to perform additional procedures was the biggest driver of OC. Hospital case mix and procedure volume indicated the magnitude of the OC.
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Affiliation(s)
- R Wahba
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Germany.
| | - A Urbanski
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Germany.
| | - R R Datta
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Germany.
| | - R Kleinert
- Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, University of Bielefeld, Bielefeld, Germany.
| | - L Bruno
- Olympus Europe SE & Co. KG aA, Germany.
| | | | - M N Thomas
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Germany.
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Han YG, Lim KM, Song T. Comparison of surgical outcomes between 3-dimensional and 2-dimensional laparoscopy of ovarian cyst (LOOC): a randomised controlled trial. J OBSTET GYNAECOL 2021; 42:1437-1442. [PMID: 34927539 DOI: 10.1080/01443615.2021.1990231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to compare the surgical outcomes and efficacy of 3-dimensional (3D) versus 2-dimensional (2D) imaging systems for the treatment of ovarian cyst. A total of 46 patients undergoing a laparoscopic ovarian cystectomy were randomly assigned to either the 3D or 2D laparoscopy group. The primary outcome measure was the operative blood loss. The secondary outcome measure was visually induced motion sickness (VIMS), task efficacy during laparoscopy, and postoperative complication. There were no differences in baseline demographics between the two groups. The operative blood loss was significantly smaller in the 3D groups (28.7 ± 11.6 mL) than in the 2D groups (46.5 ± 24.4 mL) (p = .012). VIMS score was significantly higher in the 3D groups than the 2D groups (p < .001). 3D laparoscopy was superior to 2D in terms of the task efficacy of ovarian cyst enucleation (p < .001), adhesiolysis or dissection (p < .001), and ovarian suturing (p = .008). None of the patients in both groups developed operative complications. In conclusion, a 3D imaging system showed a more favourable surgical outcome and improved task efficacy than 2D in laparoscopic ovarian cystectomy. However, 3D laparoscopy tends to cause more frequent VIMS in surgeons.Impact statementWhat is already known on this subject? Several studies examining the possible benefits and drawbacks of a 3D imaging system versus 2D in laparoscopic surgery have brought about conflicting results. However, there have been few studies comparing the surgical outcomes of 3D and 2D laparoscopic ovarian cystectomy.What do the results of this study add? 3D laparoscopy showed favourable surgical outcomes and improved task efficacy than 2D laparoscopy in ovarian cystectomy.What are the implications of these findings for clinical practice and/or further research? More complex procedures, such as suturing and adhesiolysis, might be easier to perform with 3D laparoscopy than with 2D laparoscopy. Therefore, further large studies of 3D gynaecologic laparoscopy with different complexities and for surgeons with different surgical skills are needed.
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Affiliation(s)
- Young Gi Han
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Min Lim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Intelligent Algorithm-Based Magnetic Resonance Imaging in Radical Gastrectomy under Laparoscope. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:1701447. [PMID: 34621143 PMCID: PMC8455201 DOI: 10.1155/2021/1701447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
Abstract
The study focused on the influence of intelligent algorithm-based magnetic resonance imaging (MRI) on short-term curative effects of laparoscopic radical gastrectomy for gastric cancer. A convolutional neural network- (CNN-) based algorithm was used to segment MRI images of patients with gastric cancer, and 158 subjects admitted at hospital were selected as research subjects and randomly divided into the 3D laparoscopy group and 2D laparoscopy group, with 79 cases in each group. The two groups were compared for operation time, intraoperative blood loss, number of dissected lymph nodes, exhaust time, time to get out of bed, postoperative hospital stay, and postoperative complications. The results showed that the CNN-based algorithm had high accuracy with clear contours. The similarity coefficient (DSC) was 0.89, the sensitivity was 0.93, and the average time to process an image was 1.1 min. The 3D laparoscopic group had shorter operation time (86.3 ± 21.0 min vs. 98 ± 23.3 min) and less intraoperative blood loss (200 ± 27.6 mL vs. 209 ± 29.8 mL) than the 2D laparoscopic group, and the difference was statistically significant (P < 0.05). The number of dissected lymph nodes was 38.4 ± 8.5 in the 3D group and 36.1 ± 6.0 in the 2D group, showing no statistically significant difference (P > 0.05). At the same time, no statistically significant difference was noted in postoperative exhaust time, time to get out of bed, postoperative hospital stay, and the incidence of complications (P > 0.05). It was concluded that the algorithm in this study can accurately segment the target area, providing a basis for the preoperative examination of gastric cancer, and that 3D laparoscopic surgery can shorten the operation time and reduce intraoperative bleeding, while achieving similar short-term curative effects to 2D laparoscopy.
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Song T, Kang DY. Three-dimensional versus two-dimensional laparoscopic myomectomy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2021; 264:271-275. [PMID: 34343772 DOI: 10.1016/j.ejogrb.2021.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to compare the surgical outcomes of three-dimensional (3D) and two-dimensional (2D) laparoscopic myomectomy. STUDY DESIGN A total of 64 patients with symptomatic uterine fibroids were randomly assigned to either the 3D (n = 32) group or the 2D group (n = 32). The primary outcomes were the operative blood loss and change in hemoglobin levels. The secondary outcome was operative time. RESULTS There were no differences in the baseline demographics between the two groups. The 3D and 2D groups were not significantly different in terms of operative blood loss (129.5 ± 86.5 mL vs. 140.9 ± 89.8 mL, P = 0.412), change in serum hemoglobin levels (1.4 ± 1.6 g/dL vs. 1.6 ± 1.6 g/dL, P = 0.553), and operative time (77.4 ± 37.8 min vs. 82.4 ± 35.4 min, P = 0.344). Furthermore, no differences were observed between the groups with regard to other surgical outcomes. CONCLUSION The 3D imaging system had no additional surgical benefit in laparoscopic myomectomy compared with to the conventional 2D imaging system.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Du-Young Kang
- Department of Thoracic and Cardiovacular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Short-term comparative study of three-dimensional and two-dimensional laparoscopic surgery for total extraperitoneal primary inguinal hernia repair. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:98-103. [PMID: 35600788 PMCID: PMC8965998 DOI: 10.7602/jmis.2021.24.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
Purpose The aim of this study was to compare the short-term outcomes of two-dimensional (2D) and three-dimensional (3D) laparoscopic surgery for total extraperitoneal (TEP) primary inguinal hernia repair. Methods This was a single-center, retrospective, observational database study of 38 patients who underwent laparoscopic TEP inguinal hernia repair from March 1, 2019 to August 30, 2019 at Kyung Hee University Hospital at Gangdong in Seoul, Korea. Results There was no significant difference in sex ratio, age, or body mass index between the two groups. The 2D group had two patients with direct hernia and 18 patients with indirect hernia. The 3D group had five patients with direct hernia, 11 patients with indirect hernia, and two patients with femoral hernia. The mean operation time was 38.2 minutes in the 2D group compared with 37.2 minutes in the 3D group. There was no severe intraoperative bleeding in either group. During the operation, peritoneal tearing occurred in 12 out of 20 patients in the 2D group compared with five out of 18 patients in the 3D group (p = 0.02). The average length of hospital stay was 1.3 days in both groups. The numeric rating scale score was 3.3 and 3 in the 2D group and the 3D group, respectively. In the 2D group, two patients revisited the outpatient clinic because of the postoperative occurrence of seroma and varicocele. Conclusion A 3D laparoscopic surgery is feasible and safe for inguinal hernia repair and showed less peritoneal tearing compared with 2D laparoscopic surgery for primary inguinal hernia repair.
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Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, Lai H, Mo X. Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. World J Surg Oncol 2021; 19:23. [PMID: 33478479 PMCID: PMC7819346 DOI: 10.1186/s12957-021-02134-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/13/2021] [Indexed: 01/11/2023] Open
Abstract
Background The use of 3-dimensional (3D) endoscopic thyroidectomy (ET) has been increasing, but its feasibility and safety have not been well documented for thyroidectomy. Hence, to systematically investigate the comparative outcomes during 3D-ET and 2-dimensional (2D) ET for benign and malignant lesions, we conducted this meta-analysis. Methods Based on the PRISMA guidelines, a systematic database search of the PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Chinese Wanfang databases was performed. The eligible studies were published in English and Chinese up to October 2020. The major endpoints evaluated were procedure time, blood loss, postoperative drainage, postoperative hospitalization, postoperative complications, total number of lymph node dissections (LNDs), and total cost. Results A total of 15 relevant studies including 1190 patients (583 for 3D-ET and 607 for 2D-ET) compared the application of 3D and 2D laparoscopic systems in thyroid surgery, of which 8 were endoscopic benign thyroidectomy (EBT) and 7 were endoscopic malignant thyroidectomy (EMT). Our meta-analysis indicated that 3D-ET generally had advantages over 2D-ET in terms of procedure time (P = 0.000), blood loss (P = 0.000), postoperative drainage (P = 0.000), postoperative complications (P = 0.000), and LNDs (P = 0.006). However, there were no significant differences between the two systems in terms of total cost (P = 0.245) or postoperative hospitalization (P = 0.068). Subgroup analysis showed consistency of the overall outcomes in each subset, but a shorter postoperative hospitalization in 3D-EBT was revealed. Conclusions Compared to 2D-ET, 3D endoscopic thyroidectomy is an efficient, safe, and reliable method with better depth perception and stereoscopic vision, and an equally satisfactory outcome. More clinical RCTs with long-term follow-up are required to reproduce these promising results. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02134-4.
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Affiliation(s)
- Zigao Huang
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Haiquan Qin
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Jiankun Liao
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Linghou Meng
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Yongjie Qin
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Baojia Li
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Hao Lai
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China
| | - Xianwei Mo
- Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, 530021, Guangxi Autonomous Region, China.
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Pantalos G, Patsouras D, Spartalis E, Dimitroulis D, Tsourouflis G, Nikiteas N. Three-dimensional Versus Two-dimensional Laparoscopic Surgery for Colorectal Cancer: Systematic Review and Meta-analysis. In Vivo 2020; 34:11-21. [PMID: 31882458 DOI: 10.21873/invivo.11740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Three-dimensional (3D) laparoscopy is being steadily adopted instead of two-dimensional (2D) for various procedures. Our aim was to compare the outcomes between 2D and 3D laparoscopic procedures for colorectal cancer in order to ascertain the safety, efficacy and potential advantages of 3D imaging systems. MATERIALS AND METHODS A systematic database search was conducted in March 2019. Comparative studies reporting clinical outcomes between patients undergoing elective colorectal procedures using either 2D or 3D laparoscopic equipment were eligible. RESULTS Six studies were selected, including 614 patients in total. Minor reduction in operative time, similar blood loss and increased number of harvested lymph nodes was noted for the 3D group. There was no difference for conversion to open surgery, time to flatus, postoperative hospital stay or postoperative complications. CONCLUSION 3D Laparoscopic surgery for colorectal cancer may result in reduction of operative time and higher lymph node yields, leading to improved survival.
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Affiliation(s)
- George Pantalos
- Second Department of Pediatric Surgery, P. & A. Kyriakou Hospital, Athens, Greece .,Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Dimitrios Patsouras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko General Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Tsourouflis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko General Hospital, University of Athens Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko General Hospital, University of Athens Medical School, Athens, Greece
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Bracale U, Merola G, Rizzuto A, Pontecorvi E, Silvestri V, Pignata G, Pirozzi F, Cuccurullo D, Sciuto A, Corcione F. Does a 3D laparoscopic approach improve surgical outcome of mininvasive right colectomy? A retrospective case-control study. Updates Surg 2020; 72:445-451. [PMID: 32232743 DOI: 10.1007/s13304-020-00755-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
Laparoscopy has gained wide acceptance due its benefits for patients. However, advanced laparoscopic procedures are still challenging. One critical issue is lack of stereoscopic vision. Despite its diffusion, the totally laparoscopic approach for right hemicolectomy (TLRC) is still debated due to its difficulty, particularly for fashioning of the ileocolic anastomosis. The aim of this multicenter study is to investigate whether 3D vision offers any advantages on surgical performance over 2D vision during TLRC. All data of consecutive patients who underwent elective TLRC for cancer at three Italian surgical centers with either 2D or 3D technology from January 2013 to December 2018 were retrieved from a computer-maintained database. A case-matched analysis using the Mantel-Haenszel method was performed. After matching, a total of 106 patients were analyzed with 53 patients in each group. Mean operative time was significantly longer for 2D-TLRC than for 3D-TLRC (153.2 ± 52.4 vs. 131 ± 51 min, p = 0.029) and a statistically significant difference in anastomosing time (p = 0.032, 19.2 ± 5.9 min vs. 21.7 ± 6.2 min for 3D and 2D group, respectively) was also recorded. No difference in the median number of harvested nodes (23 ± 11 vs. 21 ± 7 for 3D and 2D group, respectively; p = 0.48) was found. Neither intraoperative complications nor conversions occurred in the two groups. In conclusion, 3D vision appears to improve the performance of a TLRC by reducing operative time and making intracorporeal anastomosis easier. Prospective randomized studies are required to determine the real beneficial effects.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy.
| | - Giovanni Merola
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Antonia Rizzuto
- Medical and Surgical Science, University "Magna Graecia" of Catanzaro Medical School, Catanzaro, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Vania Silvestri
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili of Brescia, Brescia, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Diego Cuccurullo
- Department of General Surgery, Ospedali dei Colli Monaldi Hospital, Naples, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
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12
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Lu J, Xu BB, Zheng ZF, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Zheng CH, Huang CM, Li P. Does three-dimensional surgery affect recurrence patterns in patients with gastric cancer after laparoscopic R0 gastrectomy? Results from a 3-year follow-up phase III trial. Surg Endosc 2020; 35:113-123. [PMID: 31953725 DOI: 10.1007/s00464-020-07367-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 01/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Numerous studies have shown that the short-term efficacy of three-dimensional (3D) laparoscopic radical gastrectomy (LG) is comparable to that of two-dimensional (2D)-LG. Whether 3D-LG affects the recurrence patterns of gastric cancer (GC) patients has not been investigated. METHODS From January 2015 to April 2016, a total of 419 patients were recruited for a phase III clinical trial (NCT02327481), which compared the short-term outcomes between the 2D and 3D groups. The long-term efficacy including recurrence patterns was compared between the 2D and 3D groups in this retrospective study. Multivariate analyses were performed to determine whether 3D-LG affects the recurrence patterns. RESULTS Ultimately, 401 patients were analyzed (197 in the 2D-LG group and 204 in the 3D-LG group), and no differences were observed in the clinicopathological data between the two groups. There were no significant differences between the two groups in the recurrence types, first recurrence time or recurrence-free survival (RFS) (all p > 0.05). According to the 7th American Joint Committee on Cancer tumor-node-metastasis (TNM) staging system, both groups were stratified into pathological stages I, II, and III. The stratified analysis showed no significant differences in RFS or overall survival (OS) among patients in each subgroup (all p > 0.05). The multivariate analysis of RFS showed that tumor diameter, pTNM stage, lymphovascular invasion, and adjuvant chemotherapy were independent factors (all p < 0.05). The multivariate analysis of post-recurrence survival (PRS) showed that adjuvant chemotherapy was an independent protective factor (p = 0.043). CONCLUSIONS 3D-LG for GC did not differ significantly from 2D-LG in the effects on 3-year recurrence patterns, RFS and OS, which provides more tumor-related evidence for 3D technology. And due to the technological similarity, it may have certain reference value for robotic-assisted gastrectomy. Further multicenter, large-scale clinical trials are warranted.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhi-Fang Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
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13
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Gabrielli ME, Saun TJ, Jung JJ, Grantcharov TP. Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery. JAMA Netw Open 2020; 3:e1920084. [PMID: 31995217 PMCID: PMC6991293 DOI: 10.1001/jamanetworkopen.2019.20084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Errors and adverse events occur frequently in health care. Three-dimensional (3-D) laparoscopic systems claim to provide more realistic depth perception and better spatial orientation compared with their 2-D counterparts. OBJECTIVE To compare the association of 3-D vs 2-D systems with technical performance during laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures using a multiport intraoperative data capture system. DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed between May and December 2018, with a total of 50 LRYGB procedures performed in an academic tertiary care center; recordings of the operations were evaluated with a 30-day follow-up. All procedures were performed by the same surgical team. EXPOSURE Surgical teams used 2-D or 3-D laparoscopic systems. MAIN OUTCOMES AND MEASURES Technical performance was evaluated using the Objective Structured Assessment of Technical Skill and surgical errors and events using the Generic Error Rating Tool. RESULTS Of the 50 patients who underwent LRYGB procedures, 42 (86%) were women, with a median (interquartile range) age of 42 (35-47) years and a median (interquartile range) body mass index of 46 (42-48), with no significant demographic differences between the groups whose operations were performed using the 2-D and 3-D systems. The mean (SD) number of errors per case was significantly lower in procedures using the 3-D laparoscopic system than in those using the 2-D system (17 [6] vs 33 [2]; P < .001). The mean (SD) number of error-related events was significantly lower in procedures using the 3-D system than in those using the 2-D system (6 [2] vs 11 [4]; P < .001). Mean (SD) Objective Structured Assessment of Technical Skill scores were significantly higher when the 3-D system was used than when the 2-D system was used (28 [4] vs 22 [3]; P < .001). CONCLUSIONS AND RELEVANCE In this limited sample of LRYGB procedures, the use of a 3-D laparoscopic system was associated with a statistically significant reduction in errors and events as well as higher Objective Structured Assessment of Technical Skill scores compared with 2-D systems.
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Affiliation(s)
- Mauricio E. Gabrielli
- International Centre for Surgical Safety, St Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Centre for Biomedical Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tomas J. Saun
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James J. Jung
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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14
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Chen L, Li B, Zeng L, Zhao J, Lei J, Luo H, Yi F, Zhang W. Three-dimensional vs 2-dimensional laparoscopic gastrectomy for gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18222. [PMID: 31804348 PMCID: PMC6919538 DOI: 10.1097/md.0000000000018222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Both 3-dimensional (3D) laparoscopic gastrectomy (LG) and 2-dimensional (2D) LG are commonly used for gastric cancer (GC). To investigate their safety and efficacy, we performed this meta-analysis. METHODS PubMed, The Cochrane Library, Science Direct, Embase, Scopus, and Web of Science were systematically searched to identify relevant studies. The total number of lymph node dissections (LNDs), operation time, blood loss, postoperative hospital stay, postoperative complications, and hospitalization cost were extracted as major endpoints. RESULTS Among 904 articles that were enrolled, 9 studies were included for analysis. The 3D group was observed to have shorter operation times [95% confidence interval (CI): -0.54 to -0.06; P = .01] and less blood loss (95% CI: -0.41 to -0.19; P < .00001) than the 2D group. Compared with the 2D group, slightly higher hospitalization cost was found in the 3D group (95% CI: 0.06-0.37; P = .008). However, the outcomes among the total LNDs, postoperative hospital stay, and postoperative complications were similar. Subgroup analysis suggested that the 3D LG group had more 11p (2.22 ± 1.80 vs 1.47 ± 1.99, P = .019) and 8a (2.52 ± 1.88 vs 1.48 ± 1.43, P = .001) LNDs compared to the 2D LG group. CONCLUSIONS 3D LG has advantages for GC, with shorter operation times, less blood loss, and possibly more LNDs. However, the cost was slightly higher than that of 2D LG.
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Affiliation(s)
- Lian Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University
- Jiangxi Medical College, Nanchang University
| | - Bo Li
- Jiangxi Medical College, Nanchang University
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University
| | - Lianli Zeng
- Jiangxi Medical College, Nanchang University
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University
| | - Jiani Zhao
- Jiangxi Medical College, Nanchang University
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University
| | - Jun Lei
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University
| | - Hongliang Luo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University
| | - Fengming Yi
- Department of Digestive Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University
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15
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Prudhomme T, Roumiguié M, Benoit T, Lesourd M, Beauval JB, Doumerc N, Sallusto F, Soulié M, Kamar N, Gamé X. Laparoscopy for living donor left nephrectomy: Comparison of three-dimensional and two-dimensional vision. Clin Transplant 2019; 33:e13745. [PMID: 31665808 DOI: 10.1111/ctr.13745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/29/2019] [Accepted: 10/21/2019] [Indexed: 12/01/2022]
Abstract
The main objective of this preliminary study was to evaluate the feasibility and safety of 3-D laparoscopic living donor left nephrectomy (LDLN). The secondary objective was to compare intraoperative and postoperative outcomes between 3-D and 2-D laparoscopic LDLN. All patients who underwent a laparoscopic LDLN from January 2015 to April 2018 in a university center were included. All surgeries were performed by three experienced surgeons. Seventy three patients were included the following: 16 underwent a 3-D laparoscopic LDLN (3-D group), and 57 underwent a 2-D laparoscopic LDLN (2-D group). Operative time and warm ischemia time (WIT) were significantly lower in the 3-D group (operative time: 80.9 ± 10.2 vs 114.1 ± 32.3 minutes in the 3-D and 2-D groups, P = .0002) (WIT: 1.7 ± 0.6 vs 2.3 ± 0.9 minutes in the 3-D and 2-D groups, P = .02). No conversion to open surgery occurred in both groups. Length of hospital stay was significantly shorter in the 3-D group. No major postoperative complications (Clavien ≥ III) occurred. One-year postoperative GFR was similar to 3-D and 2-D groups. Our preliminary study demonstrates that 3-D laparoscopic LDLN is a feasible and safe surgical procedure. Intraoperative and postoperative outcomes were similar in both 2-D and 3-D vision systems, but 3-D vision systems allow reduction in WIT and operative time.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Thibaut Benoit
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Marine Lesourd
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | | | - Nicolas Doumerc
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Federico Sallusto
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Michel Soulié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Xavier Gamé
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
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16
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Dirie NI, Wang Q, Wang S. Two-Dimensional Versus Three-Dimensional Laparoscopic Systems in Urology: A Systematic Review and Meta-Analysis. J Endourol 2019; 32:781-790. [PMID: 29969912 PMCID: PMC6156697 DOI: 10.1089/end.2018.0411] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the three-dimensional (3D) laparoscopic system in comparison with two-dimensional (2D) laparoscopy for treatment of different urological conditions. METHODS Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in Web of Science, PubMed, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2018. Articles published in the English language of both randomized and observational studies comparing 3D and 2D laparoscopic systems in urological surgeries were included. Level of evidence and quality assessments of all included studies were conducted. Interested data were extracted for comparison and meta-analysis. RESULTS Our literature search generated 17 studies comparing 3D and 2D laparoscopic systems in different urological surgeries. Of these, 13 studies containing 548 and 449 patients operated on with 2D and 3D laparoscopic systems, respectively, were included for meta-analysis. These 13 studies were divided into three groups according to surgical type. Group 1: Partial nephrectomy (PN); operative time (p = 0.19), estimated blood loss (EBL) (p = 0.51), dissecting time (p = 0.58), and suturing time (p = 0.28) were not statistically significant between 2D and 3D laparoscopic systems. However, warm ischemia time during PN was significantly shorter during 3D laparoscopy (p < 0.00001). Group 2: Pyeloplasty; this procedure showed no significant difference between the two systems. Group 3: Radical prostatectomy (RP); shorter operative time (p < 0.0001) and lower EBL (p = 0.001) were associated with the 3D laparoscopic system. CONCLUSION Three-dimensional laparoscopy mainly improves the depth of perception, leading to better visibility, which is important for some complex urological surgeries such as PN, pyeloplasty, and RP. Based on our findings, 3D laparoscopy seems to provide better clinical and surgical outcomes in some urological procedures compared with conventional 2D laparoscopy.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
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17
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Lu J, Xu Y, Wu Y, Huang XY, Xie JW, Wang JB, Lin JX, Li P, Zheng CH, Huang AM, Huang CM. Tumor-infiltrating CD8+ T cells combined with tumor-associated CD68+ macrophages predict postoperative prognosis and adjuvant chemotherapy benefit in resected gastric cancer. BMC Cancer 2019; 19:920. [PMID: 31521128 PMCID: PMC6744628 DOI: 10.1186/s12885-019-6089-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/26/2019] [Indexed: 01/08/2023] Open
Abstract
Background Tumor-infiltrating immune cells are present in various malignant tumors, but their clinical significance in gastric cancer (GC) remains unclear. This study aimed to investigate the prognostic significance of tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs). Methods Using a prospective database containing 401 cases of GC, we evaluated TIL (cluster of differentiation 8 (CD8) expression) and TAM (cluster of differentiation 68 (CD68) expression) statuses via immunohistochemical staining. Results Compared with CD8+ TIL-negative cases (n = 196, 48.6%), CD8+ TIL-positive cases (n = 205, 51.1%) showed significantly better recurrence-free survival (RFS) [log-rank p<0.001; multivariate HR: 0.372; 95% confidence interval (CI): 0.239–0.579, p<0.001]. In contrast, compared with CD68+ TAM-negative cases (n = 217, 54.1%), CD68+ TAM-positive cases (n = 184, 45.9%) had significantly poor RFS [log-rank p<0.001; multivariate HR: 2.182; 95% CI: 1.435–3.318, p<0.001]. Thus, patients with a positive CD8+ TIL and negative CD68+ TAM status exhibited significantly increased RFS. Multivariate analysis demonstrated that CD8+ TILs and CD68+ TAMs may serve as independent prognostic markers for RFS. Incorporating CD8+ TIL and CD68+ TAM statuses into the AJCC TNM system generated a predictive model with better predictive accuracy for RFS. More importantly, patients with a positive TIL and negative TAM status showed a tendency of improved RFS after postoperative adjuvant chemotherapy (PAC). Similar results were obtained by overall survival (OS) analysis. Conclusions CD8+ TIL and CD68+ TAM statuses were identified as independent prognostic factors that may be integrated into the current TNM staging system to refine risk stratification and to better predict the survival benefit from PAC in patients with GC. Trial registration The current controlled trial was registered at ClinicalTrials.gov (ID: NCT02327481) on December 30, 2014. Electronic supplementary material The online version of this article (10.1186/s12885-019-6089-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Yu Xu
- Department of Pathology, the School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China.,lnstitue of Oncology of Fujian Medical University, Fuzhou, China
| | - Yuan Wu
- Department of Pathology, the School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China.,lnstitue of Oncology of Fujian Medical University, Fuzhou, China
| | - Xiao-Yan Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
| | - Ai-Min Huang
- Department of Pathology, the School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China. .,lnstitue of Oncology of Fujian Medical University, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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18
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The predictive value of the preoperative C-reactive protein-albumin ratio for early recurrence and chemotherapy benefit in patients with gastric cancer after radical gastrectomy: using randomized phase III trial data. Gastric Cancer 2019; 22:1016-1028. [PMID: 30739259 DOI: 10.1007/s10120-019-00936-w] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The definition and predictors of early recurrence (ER) for gastric cancer (GC) patients after radical gastrectomy are unclear. METHODS A minimum-p value approach was used to evaluate the optimal cutoff value of recurrence-free survival to determine ER and late recurrence (LR). Receiver operating characteristic curves were generated for inflammatory indices. Potential risk factors for ER were assessed with a Cox regression model. A decision curve analysis was performed to evaluate the clinical utility. RESULTS A total of 401 patients recruited in a clinical trial (NCT02327481) from January 2015 to April 2016 were included in this study. The optimal length of recurrence-free survival to distinguish between ER (n = 44) and LR (n = 52) was 12 months. Factors associated with ER included a preoperative C-reactive protein-albumin ratio (CAR) ≥ 0.131, stage III and postoperative adjuvant chemotherapy (PAC) > 3 cycles. The risk model consisting of both the CAR and TNM stage had a higher predictive ability and better clinical utility than TNM stage alone. Further stratification analysis of the stage III patients found that for the patients with a CAR < 0.131, both PAC with 1-3 cycles (p = 0.029) and > 3 cycles (p < 0.001) could reduce the risk of ER. However, for patients with a CAR ≥ 0.131, a benefit was observed only if they received PAC > 3 cycles (54.2% vs 16.0%, p = 0.004), rather than 1-3 cycles (58.3% vs 54.2%, p = 0.824). CONCLUSIONS A recurrence-free interval of 12 months was found to be the optimal threshold for differentiating between ER and LR. Preoperative CAR was a promising predictor of ER and PAC response. PAC with 1-3 cycles may not exert a protective effect against ER for stage III GC patients with CAR ≥ 0.131.
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Li J, Xi H, Guo X, Gao Y, Xie T, Qiao Z, Chen L. Surgical outcomes and learning curve analysis of robotic gastrectomy for gastric cancer: Multidimensional analysis compared with three‑dimensional high‑definition laparoscopic gastrectomy. Int J Oncol 2019; 55:733-744. [PMID: 31364736 DOI: 10.3892/ijo.2019.4851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/04/2019] [Indexed: 11/06/2022] Open
Abstract
The present ambispective cohort study was performed to compare the short‑term surgical outcomes, including financial cost and surgeons' acceptance, of robotic versus three‑dimensional high‑definition (3D‑HD) laparoscopic gastrectomy for patients with gastric cancer (GC). Between 2011 and 2017, 517 patients with GC were enrolled for treatment with either robotic gastrectomy [408 patients, including 73 treated by one of the authors (LC)] or 3D‑HD laparoscopic gastrectomy (109 patients, including 71 treated by LC). The cumulative summation method was developed to analyze the learning curves of robotic and 3D‑HD laparoscopic gastrectomy performed by LC. In the analysis of all 517 patients, there were no significant differences in the clinicopathological characteristics between the two treatment groups, with the exception of smoking status (P<0.001). The robotic group had a shorter operative time (OT; 209 vs. 228 min, P=0.004), fewer postoperative days (PODs) to first flatus (3 vs. 4 days, P=0.025), more PODs to removal of the drainage and nasogastric tubes (12 vs. 9 days, P=0.001; 6 vs. 4 days, P=0.001, respectively), and more postoperative complications (21.3 vs. 9.2%, P=0.003). Comparison of these short‑term outcomes of robotic and 3D‑HD laparoscopic gastrectomy performed by LC (144 patients) revealed that only the number of retrieved lymph nodes (27 in the robotic group vs. 33 in the 3D‑HD group; P=0.038) and PODs to removal of the nasogastric tube (5 days in the robotic group vs. 3 days in the 3D‑HD group; P<0.001) were significantly different. The OT stabilized after around 21 robotic gastrectomy procedures and 19 3D‑HD laparoscopic gastrectomy procedures. The cost‑effectiveness analysis revealed that robotic gastrectomy had a significantly higher total cost than 3D‑HD laparoscopic gastrectomy (124,907 vs. 94,395 RMB, P<0.001). With comparable surgical outcomes, lower financial cost and higher surgeons' acceptance, 3D‑HD laparoscopic gastrectomy is highly recommended as a minimally invasive surgical method for patients with GC prior to the popularization of robotic surgery.
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Affiliation(s)
- Jiyang Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Hongqing Xi
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Xin Guo
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yunhe Gao
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Tianyu Xie
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Zhi Qiao
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Lin Chen
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Ma Z, Shi G, Chen X, Zhao S, Yang L, Ding W, Wang X. Laparoscopic splenic hilar lymph node dissection for advanced gastric cancer: to be or not to be. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:343. [PMID: 31475213 DOI: 10.21037/atm.2019.07.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The incidence of proximal gastric cancer has increased in both the East and the West. Although some novel reconstructions like double-tract or double-flap anti-reflux procedure related to proximal gastrectomy are promising, total radical gastrectomy still accounts for a significant portion of these procedures. D2 radical gastrectomy is the globally accepted standard surgical procedure for advanced gastric cancer, and lymph node (LN) dissection is considered as the critical point of radical surgery and closely related to the prognosis. The splenic hilar LNs (No. 10) are LNs that need to be removed during standard D2 surgery for proximal and total gastrectomy. Lymphadenectomy does not only provide valuable information on the prognosis of gastric cancer, but the thoroughness of the sweep itself is directly related to postoperative survival. The incidence of splenic hilar LN (No. 10) metastasis rate is not high. Although the LN metastasis pathway around the spleen is complicated, the feasibility of laparoscopic splenic hilar LN dissection in locally advanced gastric cancer has been verified. However, these results are mostly from small volume clinical studies, and the fact is that the dissection of the splenic hilar is technique-demanding even for open surgery. The rational strategy for LN dissection for surgeons is still controversial. For splenic LN dissection in radical gastric cancer surgery, whether to select individualized splenic LN dissection for those patients highly suspected of clinical metastasis or to advocate the evidence-based strategy and neglect dissection in lower risk patients to avoid over-removing of LNs, is a vital question that needs to be clarified.
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Affiliation(s)
- Zhiming Ma
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Guang Shi
- Department of Oncology & Hematology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Xin Chen
- Department of Gastroenterology and Endoscopy Center, The Second Hospital of Jilin University, Changchun 130041, China
| | - Shutao Zhao
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Wei Ding
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Xudong Wang
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
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Two-dimensional versus three-dimensional laparoscopic gastrectomy in surgical efficacy for gastric cancer: a systematic review and meta-analysis. Clin Transl Oncol 2019; 22:122-129. [DOI: 10.1007/s12094-019-02116-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/11/2019] [Indexed: 01/04/2023]
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Lee Y, Lee CM, Jang YJ, Park S, Park SH, Mok YJ, Kim JH. Comparison of Short-Term Outcomes Using Three-Dimensional and Two-Dimensional Laparoscopic Gastrectomy for Gastric Cancer. J Laparoendosc Adv Surg Tech A 2019; 29:886-890. [PMID: 31058571 DOI: 10.1089/lap.2018.0765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction: This study investigated the oncological and technical advantages of three-dimensional (3D) versus two-dimensional (2D) laparoscopic gastric cancer surgery. Materials and Methods: This study included 68 gastric cancer patients who had undergone laparoscopic distal gastrectomy at Korea University Ansan Hospital (3D group, n = 34; 2D group, n = 34). The surgical outcomes and duration of each phase were compared between the groups. Results: The total operative time with 3D laparoscopy was significantly shorter than with 2D laparoscopy (227.8 ± 39.0 versus 249.6 ± 45.3 minutes; P = .037). There were no significant differences between the groups in the number of gauze pads used, time to first postoperative flatus, and number of harvested lymph nodes (2.0 [1.0-2.0] versus 2.0 [1.0-2.0]; P = .692; 4.0 [4.0-4.0] versus 4.0 [4.0-4.0] days; P = .196; 40.8 ± 16.6 versus 44.0 ± 15.7; P = .412, respectively). The time from omentectomy to right gastric artery ligation and the duration of the reconstruction phase were shorter with 3D than with 2D laparoscopy (62.6 ± 14.5 versus 71.9 ± 18.8 minutes; P = .027; 32.3 ± 7.6 versus 47.7 ± 16.8 minutes; P < .001). Conclusion: In a procedure requiring spatial perception, the operative time was shortened by introducing 3D laparoscopy. Despite the anticipation of a better view for lymph node dissection, the 3D image showed no advantage. Further study may be required by novice surgeons.
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Affiliation(s)
- Yoontaek Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - You Jin Jang
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seong-Heum Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young-Jae Mok
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jong-Han Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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CRP/prealbumin, a novel inflammatory index for predicting recurrence after radical resection in gastric cancer patients: post hoc analysis of a randomized phase III trial. Gastric Cancer 2019; 22:536-545. [PMID: 30377862 DOI: 10.1007/s10120-018-0892-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Serum prealbumin (PALB) can predict the prognosis of patients with gastric cancer (GC). However, the prognostic value of combination of C-reactive protein and PALB (CRP/PALB) remains unclear. METHODS A total of 419 gastric cancer patients included in a clinical trial (NCT02327481) were analyzed. The present study is a substudy of the trial. Receiver operating characteristic (ROC) curves were generated, and by calculating the areas under the curve (AUC) and the C-index, the discriminative ability of each inflammatory index was compared, including CRP/PALB, C-reactive protein/albumin, Glasgow prognostic score (GPS), modified GPS, systemic immune-inflammation index, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio. RESULTS Ultimately, 401 patients were included in this study. The optimal cutoff value of CRP/PALB was 17.7. According to this cutoff point, the entire sample was divided into a CRP/PALB < 17.7 (LCP) group and a CRP/PALB ≥ 17.7 (HCP) group, comprising 245 and 156 patients, respectively. There were 54 and 22 patients experienced recurrence in the HCP and LCP group, respectively, p < 0.001. Compared with traditional inflammatory indices, CRP/PALB had the highest AUC (0.707) and C-index (0.716), all p < 0.05. The post-recurrence survival (PRS) of patients in the HCP group was significantly shorter than that in the LCP group (p = 0.010), especially for pathological stage III patients (p = 0.015) or patients with distant (p = 0.018) or local (p = 0.023) recurrences. CONCLUSIONS The predictive value of preoperative CRP/PALB for the recurrence of GC is significantly better than traditional inflammatory indices. HCP significantly reduces the PRS, especially for pathological stage III patients or patients with distant or local recurrences.
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Three-dimensional Stereoscopic Visualization Shortens Operative Time in Laparoscopic Gastrectomy for Gastric Cancer. Sci Rep 2019; 9:4108. [PMID: 30858395 PMCID: PMC6411717 DOI: 10.1038/s41598-019-40269-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/11/2019] [Indexed: 01/06/2023] Open
Abstract
Laparoscopic gastrectomy for gastric cancer is now widely accepted and has become a standard surgery. This study investigated the advantages of three-dimensional (3D) stereoscopic visualization for laparoscopic gastrectomy over a conventional two-dimensional (2D) planar screen. The primary outcome of this study was operative time. Ninety-four consecutive cases of gastric cancer patients who underwent laparoscopic total gastrectomy (LTG) (25 cases) or laparoscopic distal gastrectomy (LDG) (69 cases) were enrolled in this study before and after the introduction of the 3D system. Operative time was significantly shorter in the 3D groups for both LTG (351 vs. 406 min, P = 0.026) and LDG (269 vs. 344 min, P < 0.01). During intracorporeal procedures, dissection time was significantly shorter in the 3D groups for both LTG (183 vs. 232 min, P = 0.011) and LDG (161 vs. 213 min, P < 0.01), although the time needed for anastomosis was similar between the groups. However, operators preferred intracorporeal knot-tying as a ligature for anastomosis under 3D (LTG, P = 0.012; LDG, P < 0.01). These data suggest that 3D stereoscopic visualization shortens the operative time of laparoscopic gastrectomy by reducing the intracorporeal dissection time.
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25
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The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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26
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Arezzo A, Vettoretto N, Francis NK, Bonino MA, Curtis NJ, Amparore D, Arolfo S, Barberio M, Boni L, Brodie R, Bouvy N, Cassinotti E, Carus T, Checcucci E, Custers P, Diana M, Jansen M, Jaspers J, Marom G, Momose K, Müller-Stich BP, Nakajima K, Nickel F, Perretta S, Porpiglia F, Sánchez-Margallo F, Sánchez-Margallo JA, Schijven M, Silecchia G, Passera R, Mintz Y. The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018; 33:3251-3274. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Nereo Vettoretto
- Montichiari Surgery, ASST Spedali Civili Brescia, Montichiari, Italy
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | - Marco Augusto Bonino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Nathan J Curtis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK.,Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - Daniele Amparore
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Manuel Barberio
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Ronit Brodie
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Thomas Carus
- Department of Surgery, Center for Minimally Invasive Surgery, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - Enrico Checcucci
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Petra Custers
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Marilou Jansen
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Joris Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gadi Marom
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kota Momose
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Beat P Müller-Stich
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Kyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Felix Nickel
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Silvana Perretta
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Francesco Porpiglia
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | | | | | - Marlies Schijven
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Passera
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Yoav Mintz
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Liang H, Liang W, Lei Z, Liu Z, Wang W, He J, Zeng Y, Huang W, Wang M, Chen Y, He J. Three-Dimensional Versus Two-Dimensional Video-Assisted Endoscopic Surgery: A Meta-analysis of Clinical Data. World J Surg 2018; 42:3658-3668. [PMID: 29946785 DOI: 10.1007/s00268-018-4681-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND There have been no studies to systematically evaluate the two display (3D vs. 2D) systems regarding both laparoscopic and thoracoscopic surgeries in clinical settings; thus, we conducted one to evaluate the safety and efficacy of different visualization systems (two-dimensional and three-dimensional) during endoscopic surgery (laparoscopy or thoracoscopy) in clinical settings. METHODS A comprehensive search of online databases was performed. Perioperative outcomes were synthesized. Cumulative meta-analysis was performed to evaluate the temporal trend of pooled outcomes. Specific subgroups (laparoscopy vs. thoracoscopy, prospective vs. retrospective study, malignant vs. benign diseases) were examined. Meta-regression was conducted to explore the source of heterogeneity. RESULTS Twenty-three articles were considered in this analysis, of which 7 were thoracoscopic and 16 were laparoscopic surgeries. A total of 2930 patients were recorded, of which 1367 underwent 3D video-assisted surgery and 1563 underwent 2D display. Overall, significantly shorter operating time (SMD -0.69; p = <0.001), less blood loss (SMD -0.26; p = 0.028) and shorter hospital stays (SMD -0.16; p = 0.016) were found in the 3D display group. Meanwhile, the perioperative morbidity (OR 0.92; p = 0.487), retrieved lymph nodes (SMD 0.09; p = 0.081), drainage duration (SMD -0.15; p = 0.105) and drainage volume (SMD 0.00; p = 0.994) were similar between the two groups. Comparison of the overall outcomes in each subset showed consistency in all groups. CONCLUSIONS This up-to-date meta-analysis reveals that the 3D display system is superior to the 2D system in clinical settings with significantly shorter operating time, less blood loss and shorter hospital stay. These findings suggest that, in laparoscopic or thoracoscopic surgeries, 3D endoscopic system is preferable when condition permits. Future efforts should be made on decreasing the side effects of 3D display and increasing its cost-effectiveness.
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Affiliation(s)
- Hengrui Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Wenhua Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Zhao Lei
- The Sixth Affiliated Hospital, School of Basic Medical Sciences, Functional Experiment Center, Guangzhou Medical University, Guangzhou, 511436, China
| | - Zhichao Liu
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Wei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jiaxi He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yuan Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Weizhe Huang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Manting Wang
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yuehan Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China.
- National Clinical Research Center for Respiratory Center for Respiratory Disease, Guangzhou, 510120, China.
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Zundel S, Lehnick D, Heyne-Pietschmann M, Trück M, Szavay P. A Suggestion on How to Compare 2D and 3D Laparoscopy: A Qualitative Analysis of the Literature and Randomized Pilot Study. J Laparoendosc Adv Surg Tech A 2018; 29:114-120. [PMID: 30256710 DOI: 10.1089/lap.2018.0164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND AIMS The results of studies comparing two-dimensional (2D) and three-dimensional (3D) laparoscopy have shown variable results. We aimed to review the literature and develop an appropriate instrument to compare 2D and 3D laparoscopy. We further aimed to use the data extracted to perform a pilot study. METHODS Sixty-seven recent articles on 3D laparoscopy were reviewed and data extracted on factors influencing outcome variables. These variables were used to design a pilot study of 28 novices using a randomized crossover design. The results were analyzed using descriptive statistics and the Wilcoxon signed-rank tests. RESULTS Seven themes were identified to influence the outcome of 3D studies: applied technique (1), experience of subjects (2), study design (3), learning curve (4), subjective qualitative reports (5), laparoscopic tasks (6), and chosen outcome variables (7). The consecutively developed five laparoscopic simulation tasks contained placing a rubber band over hooks, ring and pearl transfer, threading a pipe cleaner through loops, and placing a suturise. The pilot study showed a primary benefit of 3D laparoscopy that was unrelated to repetition. Two tasks served well to assess first-time performance, and two tasks promise to serve well to assess a learning curve if performed repeatedly. CONCLUSION We were able to identify important issues influencing the outcome of studies analyzing 3D laparoscopy. These may help evaluate future studies. The developed tasks resulted in meaningful data in favor of 3D visualization, but further studies are necessary to confirm the pilot test results.
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Affiliation(s)
- Sabine Zundel
- 1 Department of Pediatric Surgery, Children's Hospital, Lucerne, Switzerland
| | - Dirk Lehnick
- 2 Faculty of Humanities and Social Sciences, Department of Health Sciences and Health Policy, University of Lucerne, Luzern, Switzerland
| | | | - Mike Trück
- 1 Department of Pediatric Surgery, Children's Hospital, Lucerne, Switzerland
| | - Philipp Szavay
- 1 Department of Pediatric Surgery, Children's Hospital, Lucerne, Switzerland
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29
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Zheng CH, Lu J, Zheng HL, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang CM. Comparison of 3D laparoscopic gastrectomy with a 2D procedure for gastric cancer: A phase 3 randomized controlled trial. Surgery 2017; 163:300-304. [PMID: 29195739 DOI: 10.1016/j.surg.2017.09.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relative safety and efficacy of 3D laparoscopic gastrectomy and 2D laparoscopic surgery in patients with gastric cancer. BACKGROUND There is still a lack of randomized controlled trials regarding the safety and efficacy of 3D versus 2D laparoscopic surgery for gastric cancer. METHODS A large-scale, phase 3, prospective, randomized controlled trial was conducted. (ClinicalTrials.gov number NCT02327481). RESULTS A total of 438 patients were randomized (3D group: 219 cases; 2D group: 219 cases) between January 1, 2015, and April 1, 2016; 19 patients were excluded. Finally, data from 419 patients were analyzed (3D group: 211 cases; 2D group: 208 cases). There were no differences between the 2 groups regarding the operation time (3D versus 2D, 176 ± 35 min vs. 174 ± 33 min, P = .562). The intraoperative blood loss in the 3D group was somewhat less than in the 2D group (61 ± 83 mL vs. 82 ± 119 mL, P = .045). Further analysis suggested that the use of 3D laparoscopic surgery was a protective factor against excessive blood loss (≥200 mL). CONCLUSION 3D laparoscopic gastrectomy did not shorten the operation time compared with 2D laparoscopic gastrectomy, but provided the benefit of less intraoperative blood loss and a lesser occurrence of excessive bleeding than the conventional 2D laparoscopic gastrectomy; the clinical value of the difference is limited.
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Affiliation(s)
- Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian Province, China.
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Comparison of two- and three-dimensional display for performance of laparoscopic total gastrectomy for gastric cancer. Langenbecks Arch Surg 2017; 402:493-500. [PMID: 28314905 DOI: 10.1007/s00423-017-1574-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/08/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE Introduction of three-dimensional (3D) display might remove technical obstacles of laparoscopic surgery and improve laparoscopic skills. We analyzed the effect of 3D technology on operative performance during laparoscopic total gastrectomy (LTG) for gastric cancer and assessed its advantages over two-dimensional (2D) laparoscopy. METHODS This study included 30 consecutive surgeries of LTG with esophagojejunostomy by the overlap method performed (3D group, n = 15, 2D group, n = 15). The surgical outcomes were compared between the 3D and 2D groups. Further, we compared the performance time, the frequency of bleeding requiring hemostasis, and the frequency of remaking the surgical view by the assistant's forceps in each laparoscopic scene between the 3D and 2D groups. RESULTS All surgeries were completed without any complications. The total time of pure laparoscopic scenes was shorter in the 3D than 2D group (154.2 vs. 182.7 min, P = 0.026), and total blood loss was almost the same (10 vs. 20 g, P = 0.195). The operative time during lymphadenectomy in scenes 6 and 7 were significantly shorter in the 3D than the 2D group (scene 6, 13.5 vs. 17.5 min, P = 0.003, and scene 7, 12.4 vs. 18.4, P = 0.025) and esophagojejunostomy (30.3 vs. 39.4 min, P = 0.008). The frequency of tissue exposure by the assistant was significantly less in the 3D group than the 2D group in scenes 6 and 7 (scene 6, n = 3.0 vs. 4.0, P = 0.006, and scene 7, n = 3.0 vs. 4.0, P = 0.017). CONCLUSIONS 3D display is useful due to improvement of surgical skill during difficult situations such as lymphadenectomy around the celiac artery, which requires handling in the tangential view, and reconstruction using the suturing technique in a narrow space.
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