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Vörös V, De Smet J, Ourak M, Poliakov V, Deprest J, Kimpe T, Vander Poorten E. Comparison of 2D and autostereoscopic 3D visualization during mixed reality simulation. Int J Comput Assist Radiol Surg 2023; 18:1679-1686. [PMID: 36995512 DOI: 10.1007/s11548-023-02876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE In general minimally invasive surgical procedures, surgeons are tied to 2D visualization, leading to the loss of depth perception. This can lead to large mental load for the surgeons and may be responsible for the long learning curve. To restore the sense of depth, this study investigated the use and benefits of an autostereoscopic (3D) display during a simulated laparoscopic task. METHODS A mixed reality simulator was developed for comparing the performance of participants while using 2D and autostereoscopic 3D visualization. An electromagnetic sensor was mounted on a physical instrument, and its pose was mapped to the virtual instrument. The virtual scene was developed using Simulation Open Framework Architecture (SOFA). Finite element modeling was used to calculate interaction forces, which were then mapped to visual soft tissue deformation. RESULTS Ten non-expert participants completed a virtual laparoscopic task, where the subjects were asked to contact eighteen target areas distributed on the surface of the vagina, both in 2D and 3D. Results showed an improvement with 3D vision in task completion time (-16%), total traveled distance (-25%) and errors made (-14%). There was no difference in the average contact forces between the vagina and the instrument. Only the difference in time and forces were shown to be statistically significant. CONCLUSION Overall, autostereoscopic 3D showed superiority over conventional 2D visualization. The traveled trajectory increased in 2D as the instrument was retracted more between the targets to avoid contact. The 2D and 3D deformation upon contact seems not to contribute differently to force perception. However, the participants only had visual feedback, but no haptic feedback. Therefore, it could be interesting to include haptic feedback in a future study.
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Affiliation(s)
- Viktor Vörös
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium.
- Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium.
| | - Jef De Smet
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Vladimir Poliakov
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Tom Kimpe
- Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium
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Vörös V, Page AS, Deprest J, Kimpe T, Poorten EV. Motion and viewing analysis during minimally invasive surgery for autostereoscopic visualization. Int J Comput Assist Radiol Surg 2023; 18:527-535. [PMID: 36136179 DOI: 10.1007/s11548-022-02753-6] [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: 06/20/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Autostereoscopic 3D visualization (ASV) forms a potentially appealing alternative to stereoscopic 3D displays to help surgeons regain depth perception during minimally invasive surgery (MIS). However, the feasibility of using single-viewer ASV has not yet been demonstrated in a clinical context. The purpose of the study is to analyze the current surgical workflow and display usage and assess the potential for using ASV in MIS applications. Additionally, the study seeks to acquire a better understanding of key design requirements, such as the eye-tracking performance and the lenticular lens 3D workspace. METHODS Two types of gynecologic interventions were investigated. A vision-based tracking system was developed, consisting of depth cameras mounted on the displays and ArUco markers placed on the hair caps of clinicians and the wall of the operating room. This allowed simultaneous tracking of the pose of operating staff and displays. RESULTS Overall 20 surgeries were recorded, where 4 clinicians operated using 3 displays. Users were typically standing at a mean distance of 1900 mm in a range from to 1200 to 2300 mm from the display. Left-right motion was from - 600 to 658 mm. Clinicians stood on average 1000 mm from each other. The head roll angle was below 16[Formula: see text]. CONCLUSION Surgeons were looking predominantly (99%) to the same display. Observations took place from fairly well-defined places and with sufficient potential to differentiate between clinicians, suggesting that single-viewer ASV would be feasible.
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Affiliation(s)
- Viktor Vörös
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium. .,Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium.
| | - Ann-Sophie Page
- Department of Obstetrics and Gynaecology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Tom Kimpe
- Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium
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The relationship between visual impairments and activity of the neck/shoulder muscles among surgeons during simulated surgical tasks. Surg Endosc 2022; 36:5326-5338. [PMID: 34997342 DOI: 10.1007/s00464-021-08913-0] [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: 07/27/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Minimally Invasive Surgery (MIS) has an impact on surgeons' musculoskeletal and visual systems. However, the relationship between visual symptoms and musculoskeletal problems is not well understood. AIM OF THE STUDY This study used surface electromyography (sEMG) to examine changes in fatigue of the neck/shoulder muscles among surgeons with visual impairments when performing simulated surgical tasks in 2D and 3D viewing modes. DESIGN Cross-sectional laboratory study. METHODS Changes in median frequency (MDF, an indicator of muscle fatigue) were examined in 17 experienced gynaecologists. Four simulated surgical laparoscopy tasks were performed in 2D and 3D viewing modes. The MDF of three neck/shoulder muscles (cervical erector spinae, [CES], upper trapezii [UT], and anterior deltoids [AD]) were examined bilaterally. Visual parameters (accommodation, convergence, and stereoacuity) were measured prior to commencement. RESULTS There was a downward shift of MDF from simple to more complex tasks for the right and left CES and AD muscles but not the UT, which was consistent for surgeons with mild accommodation/convergence impairment and/or good stereoacuity. There were significant differences in the level of muscle fatigue of the neck/shoulder muscles according to the severity of visual impairment, muscle side, task and surgical performance level. CONCLUSIONS The results show a relationship between the degree of visual impairments and muscle fatigue of the neck/shoulder muscles among MIS surgeons. These findings have important implications in understanding the concurrence of musculoskeletal problems and visual symptoms.
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Beattie KL, Hill A, Horswill MS, Grove PM, Stevenson ARL. Laparoscopic skills training: the effects of viewing mode (2D vs. 3D) on skill acquisition and transfer. Surg Endosc 2021; 35:4332-4344. [PMID: 32876737 PMCID: PMC8263422 DOI: 10.1007/s00464-020-07923-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Three-dimensional (3D) visual displays have been suggested to aid laparoscopic skills training by providing the depth cues not present in traditional two-dimensional (2D) displays. However, few studies have robustly investigated the impact of viewing mode (2D vs. 3D) on learning outcomes. PURPOSE To examine how viewing mode (2D vs. 3D) impacts the acquisition and transferability of basic laparoscopic skills by comparing performance between transfer and control groups on a complete proficiency-based training program. METHOD A counterbalanced between-subjects design was employed. Each participant was randomly allocated to one of four groups, comprising two transfer groups (trained in one viewing mode and tested in the alternate mode: the 2D → 3D and 3D → 2D groups) and two control groups (trained and tested in one viewing mode: the 2D → 2D and 3D → 3D groups). Participants completed proficiency-based training in six laparoscopic training tasks. Testing included two further repetitions of all tasks under test conditions. Objective performance measures included the total number of repetitions to reach proficiency, and total performance scores (i.e. time + error penalties across all repetitions) in training and testing. RESULTS The groups trained in 3D demonstrated superior training performance (i.e. less time + errors) and took fewer repetitions to reach proficiency than the groups trained in 2D. The groups tested in 3D also demonstrated superior test performance compared to those tested in 2D. However, training mode did not yield significant test differences between the groups tested in 2D (i.e. 2D → 2D vs. 3D → 2D), or between the groups tested in 3D (i.e. 3D → 3D vs. 2D → 3D). CONCLUSION Novices demonstrate superior performance in laparoscopic skills training using a 3D viewing mode compared to 2D. However, this does not necessarily translate to superior performance in subsequent testing or enhanced learning overall. Rather, test performance appears to be dictated by the viewing mode used during testing, not that of prior training.
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Affiliation(s)
- Kirsty L Beattie
- School of Psychology, The University of Queensland, St Lucia, Brisbane, 4072, Australia.
| | - Andrew Hill
- School of Psychology, The University of Queensland, St Lucia, Brisbane, 4072, Australia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia
- Minerals Industry Safety and Health Centre, Sustainable Minerals Institute, The University of Queensland, Brisbane, Australia
| | - Mark S Horswill
- School of Psychology, The University of Queensland, St Lucia, Brisbane, 4072, Australia
| | - Philip M Grove
- School of Psychology, The University of Queensland, St Lucia, Brisbane, 4072, Australia
| | - Andrew R L Stevenson
- School of Medicine, The University of Queensland, Brisbane, Australia
- Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Alhusuny A, Cook M, Khalil A, Johnston V. Visual symptoms, Neck/shoulder problems and associated factors among surgeons performing Minimally Invasive Surgeries (MIS): A comprehensive survey. Int Arch Occup Environ Health 2021; 94:959-979. [PMID: 33515063 DOI: 10.1007/s00420-020-01642-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Minimally Invasive Surgery (MIS) is demanding on the musculoskeletal and visual systems. Prevalence, severity and association of neck/shoulder problems and visual symptoms were examined among MIS surgeons. The associations of workplace and individual factors with these symptoms independently and combined were also examined. METHODS MIS surgeons completed a comprehensive online survey inclusive of 52 questions about individual and workplace physical factors, neck/shoulder problems and visual symptoms. Binary logistic regression models were conducted to determine the associations of the neck/shoulder problems, visual symptoms and combined symptoms with workplace and individual factors. RESULTS 290 surgeons completed the survey. Neck/shoulder problems and visual symptoms were reported by 31.0% and 29.0%, respectively, 15.5% reported both problems. The prevalence and severity of neck/shoulder problems and visual symptoms were significantly associated (p < 0.001). Several workplace and individual factors were associated with these symptoms (p ≤ 0.05). CONCLUSIONS Several factors in the workplace environment (temperature, asymmetrical weight bearing and forward head movement) and individual (being female and wearing vision correction glasses) were significantly associated with neck/shoulder problems and visual symptoms. Evaluation of different strategies to minimise the strain on the neck/shoulder region and the visual system is required.
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Affiliation(s)
- Ameer Alhusuny
- School of Health and Rehabilitation Sciences, The University of Queensland, Level 3, Therapies Annexe Building 84, Brisbane, St Lucia, QLD, 4068, Australia.
| | - Margaret Cook
- School of Earth and Environmental Sciences, Faculty of Science, The University of Queensland, Brisbane, Australia
| | - Akram Khalil
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
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Zwimpfer TA, Lacher D, Fellmann-Fischer B, Mueller M. A laparoscopic study investigating 3D vs 2D imaging systems using a pelvitrainer model with experts, non-experts, and students. BMC Surg 2020; 20:276. [PMID: 33167972 PMCID: PMC7650199 DOI: 10.1186/s12893-020-00892-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Vision is an essential element of laparoscopic surgery that defines the outcome of an operation in regards to time, mistakes and precision. A 3-dimensional (3D) perspective may improve vision during an operation. Therefore, this study was designed to compare 3D versus 2-dimensional (2D) perspectives using a pelvitrainer model. METHODS Fifty candidates were divided into 3 categories based on different experience levels. The candidates were randomised into two groups, with each group performing the same 4 standardised tasks. Group A approached the tasks first with 3D high definition and in a second turn with 2D high definition. Group B carried out the tasks with the systems in reverse order. Task completion time and the number of mistakes made for each task were recorded. After completing the tasks, participants answered questions concerning the two systems. RESULTS Group A was, on average, 20% faster at all four tasks and made approximately 18% fewer mistakes in two of the tasks in comparison to group B. The experts significantly benefited from the 3D system in terms of accuracy compared to non-experts and students. The students demonstrated a significantly greater benefit from the 3D system when performing non-linear, continuous movements. Loss of concentration occurred at the same rate for subjects using the 2D and 3D systems. Nausea and dizziness were reported only when working with the 3D system. 91% found the 3D system advantageous for accomplishing the tasks. CONCLUSIONS Irrespective of experience level, 3D laparoscopy shows advantages in saving time, increasing accuracy and reducing mistakes. These benefits were also accompanied by subjective advantages that were noted by the participants. However, the more complex the task, the less significant the benefit of the 3D system and some people feel handicapped by the eyewear.
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Affiliation(s)
| | | | | | - Michael Mueller
- University Hospital Berne, Gynecological Clinic, Berne, Switzerland
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Sánchez-Margallo FM, Durán Rey D, Serrano Pascual Á, Mayol Martínez JA, Sánchez-Margallo JA. Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis. J Endourol 2020; 35:123-137. [PMID: 32799686 DOI: 10.1089/end.2020.0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. Methods: A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. Results: A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Conclusions: Three-dimensional laparoscopic systems essentially advance surgical performance in less-experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.
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Affiliation(s)
| | - David Durán Rey
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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Paradiso FV, Giannico S, La Milia D, Lohmeyer FM, Nanni L. Applicability and Effectiveness of Laparoscopic Procedures in Pediatrics. J Laparoendosc Adv Surg Tech A 2020; 30:1040-1043. [PMID: 32716272 DOI: 10.1089/lap.2018.0492] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Three-dimensional (3D) laparoscopic surgery in pediatrics is still uncommon and few studies assessed in clinical practice advantages and disadvantages. Applicability and effectiveness of 3D versus two-dimensional (2D) laparoscopic procedures in congenital and acquired conditions in children are still unknown. We assessed applicability and effectiveness of 3D compared with 2D laparoscopic procedures in a pediatric setting. Methods: Two groups of patients who underwent 3D or 2D laparoscopic surgical procedures between May 2016 and April 2018 were compared. Each 3D/2D laparoscopic procedure was assessed with a surgeon/assistant questionnaire. Results: The 3D group included 30 patients and the 2D group 32 patients. The analysis of the 3D/2D questionnaire showed statistically significant superiority of 3D technical aspects (P = .0000), allowing a better spatial orientation and depth perception, reducing manipulation and trauma to tissues. Moreover, no difference was reported in physical complaints (P = .7084), but decreased visual fatigue was highlighted by surgeon (P = .000). Conclusions: In pediatric patients, 3D laparoscopic procedures prove to be more effective facilitating the surgeon's performance, while maintaining the benefits of minimally invasive surgery.
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Affiliation(s)
- Filomena Valentina Paradiso
- Division of Pediatric Surgery, Scienze Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Serena Giannico
- Division of Pediatric Surgery, Scienze Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele La Milia
- UOC Igiene Ospedaliera, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Lorenzo Nanni
- Division of Pediatric Surgery, Scienze Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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Anschuetz L, Niederhauser L, Wimmer W, Yacoub A, Weibel D, Mast FW, Caversaccio M. Comparison of 3- vs 2-Dimensional Endoscopy Using Eye Tracking and Assessment of Cognitive Load Among Surgeons Performing Endoscopic Ear Surgery. JAMA Otolaryngol Head Neck Surg 2019; 145:838-845. [PMID: 31343675 DOI: 10.1001/jamaoto.2019.1765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Endoscopic ear surgery (EES) is an emerging technique to treat middle ear diseases; however, the interventions are performed in 2-dimensional (2D) endoscopic views, which do not provide depth perception. Recent technical developments now allow the application of 3-dimensional (3D) endoscopy in EES. Objective To investigate the usability, advantages, and disadvantages of 3D vs 2D endoscopy in EES under standardized conditions. Design, Setting, and Participants This cohort study conducted at a tertiary academic medical center in Bern, Switzerland, included 16 residents and consultants of the Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern. Interventions Each participant performed selected steps of a type I tympanoplasty and stapedotomy in 3D and 2D views in a cadaveric model using a randomized, Latin-square crossover design. Main Outcomes and Measures Time taken to perform the EES, number of attempts, and accidental damage during the dissections were compared between 3D and 2D endoscopy. Eye tracking was performed throughout the interventions. Cognitive load and subjective feedback were measured by standardized questionnaires. Results Of the 16 surgeons included in the study (11 inexperienced residents; 5 experienced consultants), 8 were women (50%); mean age was 36 years (range, 27-57 years). Assessment of surgical time revealed similar operating times for both techniques (181 seconds in 2D vs 174 seconds in 3D). A total of 64 surgical interventions were performed. Most surgeons preferred the 3D technique (10 for 3D vs 6 for 2D), even though a higher incidence of eye strain, measured on a 7-point Likert scale, was observed (3D, 2.19 points vs 2D, 1.44 points; mean difference , 0.74; 95% CI, 0.29-1.20; r = 0.67). Eye movement assessment revealed a higher duration of fixation for consultants in 2D (0.79 seconds) compared with 3D endoscopy (0.54 seconds), indicating a less-efficient application of previously acquired experiences using the new technique. Residents (mean [SD], 49.02 [16.4]) had a significantly higher workload than consultants (mean [SD], 27.21 [12.20]), independent of the used technique or task. Conclusions and Relevance Three-dimensional endoscopy is suitable for EES, especially for inexperienced surgeons whose mental model of the intervention has yet to be consolidated. The application of 3D endoscopy in clinical routines and for educational purposes may be feasible and beneficial.
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Laura Niederhauser
- Department of Psychology, Swiss University of Distance Education, Bern, Switzerland
| | - Wilhelm Wimmer
- Artificial Organ Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Abraam Yacoub
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - David Weibel
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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Is three-dimensional laparoscopic spleen preserving splenic hilar lymphadenectomy for gastric cancer better than that of two-dimensional? Analysis of a prospective clinical research study. Surg Endosc 2019; 33:3425-3435. [DOI: 10.1007/s00464-018-06640-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022]
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11
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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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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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13
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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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14
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Dias RD, Ngo-Howard MC, Boskovski MT, Zenati MA, Yule SJ. Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload. Br J Surg 2018; 105:491-501. [PMID: 29465749 PMCID: PMC5878696 DOI: 10.1002/bjs.10795] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/09/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different methods used to assess surgeons' cognitive load, and a critique of the reliability and validity of current assessment metrics. METHODS A search strategy encompassing MEDLINE, Embase, Web of Science, PsycINFO, ACM Digital Library, IEEE Xplore, PROSPERO and the Cochrane database was developed to identify peer-reviewed articles published from inception to November 2016. Quality was assessed by using the Medical Education Research Study Quality Instrument (MERSQI). A summary table was created to describe study design, setting, specialty, participants, cognitive load measures and MERSQI score. RESULTS Of 391 articles retrieved, 84 met the inclusion criteria, totalling 2053 unique participants. Most studies were carried out in a simulated setting (59 studies, 70 per cent). Sixty studies (71 per cent) used self-reporting methods, of which the NASA Task Load Index (NASA-TLX) was the most commonly applied tool (44 studies, 52 per cent). Heart rate variability analysis was the most used real-time method (11 studies, 13 per cent). CONCLUSION Self-report instruments are valuable when the aim is to assess the overall cognitive load in different surgical procedures and assess learning curves within competence-based surgical education. When the aim is to assess cognitive load related to specific operative stages, real-time tools should be used, as they allow capture of cognitive load fluctuation. A combination of both subjective and objective methods might provide optimal measurement of surgeons' cognition.
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Affiliation(s)
- R D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - M C Ngo-Howard
- Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA,Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - M T Boskovski
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - M A Zenati
- Harvard Medical School, Boston, Massachusetts, USA,Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - S J Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Correspondence to: Dr S. J. Yule, STRATUS Center for Medical Simulation, Brigham and Women's Hospital, 10 Vining Street, Boston, Massachusetts 02115, USA (e-mail: ; @RogerDaglius; @BWH_STRATUS)
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15
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2D vs. 3D imaging in laparoscopic surgery-results of a prospective randomized trial. Langenbecks Arch Surg 2017; 402:1241-1253. [PMID: 28986719 DOI: 10.1007/s00423-017-1629-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE 3D imaging is an upcoming technology in laparoscopic surgery, and recent studies have shown that the modern 3D technique is superior in an experimental setting. However, the first randomized controlled clinical trial in this context dates back to 1998 and showed no significant difference between 2D and 3D visualization using the first 3D generation technique, which is now more than 15 years old. METHODS Positive results measured in an experimental setting considering 3D imaging on surgical performance led us to initiate a randomized controlled pragmatic clinical trial to validate our findings in daily clinical routine. Standard laparoscopic operations (cholecystectomy, appendectomy) were preoperatively randomized to a 2D or 3D imaging system. We used a surgical comfort scale (Likert scale) and the Raw NASA Workload TLX for the subjective assessment of 2D and 3D imaging; the duration of surgery was also measured. RESULTS The results of 3D imaging were statistically significant better than 2D imaging concerning the parameters "own felt safety" and "task efficiency"; the difficulty level of the procedures in the 2D and 3D groups did not differ. Overall, the Raw NASA Workload TLX showed no significance between the groups. CONCLUSION 3D imaging could be a possible advantage in laparoscopic surgery. The results of our clinical trial show increased personal felt safety and efficiency of the surgeon using a 3D imaging system. Overall of the procedures, the findings assessed using Likert scales in terms of own felt safety and task efficiency were statistically significant for 3D imaging. The individually perceived workload assessed with the Raw NASA TLX shows no difference. Although these findings are subjective impressions of the performing surgeons without a clear benefit for 3D technology in clinical outcome, we think that these results show the capability that 3D laparoscopy can have a positive impact while performing laparoscopic procedures.
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16
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Rivas-Blanco I, Sánchez-de-Badajoz E, García-Morales I, Lage-Sánchez JM, Sánchez-Gallegos P, Pérez-Del-Pulgar CJ, Muñoz VF. Global vision system in laparoscopy. Actas Urol Esp 2017; 41:274-278. [PMID: 27998669 DOI: 10.1016/j.acuro.2016.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The main difficulty in laparoscopic or robot-assisted surgery is the narrow visual field, restricted by the endoscope's access port. This restriction is coupled with the difficulty of handling the instruments, which is due not only to the access port but also to the loss of depth of field and perspective due to the lack of natural lighting. In this article, we describe a global vision system and report on our initial experience in a porcine model. MATERIAL AND METHODS The global vision system consists of a series of intraabdominal devices, which increase the visual field and help recover perspective through the simulation of natural shadows. These devices are a series of high-definition cameras and LED lights, which are inserted and fixed to the wall using magnets. The system's efficacy was assessed in a varicocelectomy and nephrectomy. RESULTS The various intraabdominal cameras offer a greater number of intuitive points of view of the surgical field compared with the conventional telescope and appear to provide a similar view as that in open surgery. Areas previously inaccessible to the standard telescope can now be reached. The additional light sources create shadows that increase the perspective of the surgical field. CONCLUSION This system appears to increase the possibilities for laparoscopic or robot-assisted surgery because it offers an instant view of almost the entire abdomen, enabling more complex procedures, which currently require an open pathway.
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Affiliation(s)
- I Rivas-Blanco
- Ingeniería de Sistemas y Automática, Universidad de Málaga, Málaga, España
| | - E Sánchez-de-Badajoz
- Unidad docente de Urología, Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - I García-Morales
- Ingeniería de Sistemas y Automática, Universidad de Málaga, Málaga, España
| | | | - P Sánchez-Gallegos
- Unidad docente de Cirugía, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | | | - V F Muñoz
- Ingeniería de Sistemas y Automática, Universidad de Málaga, Málaga, España
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17
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Fergo C, Burcharth J, Pommergaard HC, Kildebro N, Rosenberg J. Three-dimensional laparoscopy vs 2-dimensional laparoscopy with high-definition technology for abdominal surgery: a systematic review. Am J Surg 2017; 213:159-170. [DOI: 10.1016/j.amjsurg.2016.07.030] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 06/19/2016] [Accepted: 07/06/2016] [Indexed: 12/30/2022]
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18
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Impact of 3D in the training of basic laparoscopic skills and its transferability to 2D environment: a prospective randomized controlled trial. Surg Endosc 2016; 31:1111-1118. [DOI: 10.1007/s00464-016-5074-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 06/22/2016] [Indexed: 11/27/2022]
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19
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Sørensen SMD, Mahmood O, Konge L, Thinggaard E, Bjerrum F. Laser visual guidance versus two-dimensional vision in laparoscopy: a randomized trial. Surg Endosc 2016; 31:112-118. [PMID: 27317036 PMCID: PMC5216078 DOI: 10.1007/s00464-016-4937-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/09/2016] [Indexed: 12/04/2022]
Abstract
Background During laparoscopy, the surgeon’s loss of depth perception and spatial orientation is problematic. Laser visual guidance (LVG) is an innovative technology that improves depth perception to enhance the visual field. In this trial, we examined the effect of LVG on surgical novices’ motor skills, quality of task performance, and cognitive workload. Methods We designed a randomized controlled trial following the CONSORT statement. Thirty-two surgical novices completed the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test. The first attempt allowed participants to familiarize themselves with the exercises. We then randomized the participants, and they completed a test session using either LVG or conventional two-dimensional vision. Results We found no significant difference between using the LVG tool and conventional 2D vision; however, both the mean completion time and movements used were less in the LVG group: Mean time used in the LVG group was 1288 s (95 % CI 1188–1388) versus 1354 s (95 % CI 1190–1518) (p = 0.45); mean angular path length used in the LVG group was 24,049° (95 % CI 20,761–27,336) versus 26,014° (95 % CI 22,059–29,970) (p = 0.42); mean path length in the LVG group was 4560 cm (95 % CI 3971–5,149 cm) versus 5062 cm (95 % CI 4328–5797), (p = 0.26). Moreover, the mean TABLT performance score was higher in the LVG group compared with the 2D group, although not significant: 379 (95 % CI 352–405) versus 338 (95 % CI 288–387) (p = 0.14). No significant difference was found between the groups’ cognitive workloads. Conclusion We found no significant improvement of laparoscopic motor skills when using LVG, although a tendency toward improved performance was seen. LVG could have the potential to help novice surgeons acquire basic laparoscopic; however, further development of the concept and validation is needed to confirm this.
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Affiliation(s)
- Stine Maya Dreier Sørensen
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark. .,University of Copenhagen, Copenhagen, Denmark.
| | - Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Ebbe Thinggaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - Flemming Bjerrum
- University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
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20
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Fanfani F, Rossitto C, Restaino S, Ercoli A, Chiantera V, Monterossi G, Barbati G, Scambia G. How Technology Can Impact Surgeon Performance: A Randomized Trial Comparing 3-Dimensional versus 2-Dimensional Laparoscopy in Gynecology Oncology. J Minim Invasive Gynecol 2016; 23:810-7. [PMID: 27046747 DOI: 10.1016/j.jmig.2016.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 11/19/2022]
Abstract
This randomized clinical trial (Canadian Task Force classification I) aimed to compare 2-dimension (2-D) versus 3-dimensional (3-D) laparoscopic hysterectomy and pelvic lymphadenectomy in endometrial and cervical cancer patients. Between December 2014 and March 2015, 90 patients were enrolled: 29 (32.2%) with early or locally advanced cervical cancer after neoadjuvant treatment and 61 (67.8%) with early-stage endometrial cancer. Patients were randomly assigned to undergo 2-D (Group A, n = 48 [53.3%]) or 3-D (Group B, n = 42 [46.7%)]) laparoscopy. Baseline characteristics were superimposable in the 2 groups. Median operative time was similar in the 2 groups. Median estimated blood loss during lymphadenectomy was significantly lower in Group B than in Group A (38 mL [range, 0-450] vs 65 mL [range, 0-200]; p = .033). In cervical cancer patients operative time of pelvic lymphadenectomy performed by "novice" surgeons (those with <10 procedures performed) was statistically significantly lower in Group B (p = .047). No differences in perioperative outcomes and postoperative complications were observed between the 2 groups. The 2-D and 3-D systems can be used safely in laparoscopic hysterectomy. However, the 3-D system could provide key benefits to intraoperative techniques and postoperative outcomes in reducing operative time for "expert" surgeons and in enhancing surgical precision for "novice" surgeons.
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Affiliation(s)
- Francesco Fanfani
- Department of Medicine and Aging Sciences, University "G.D'Annunzio", Chieti-Pescara, Italy.
| | - Cristiano Rossitto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Stefano Restaino
- Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University Hospital Maggiore della Carità, Novara, Italy
| | - Vito Chiantera
- Department of Obstetrics and Gynecology, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Giorgia Monterossi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Giulia Barbati
- Medicine Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
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