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Elisei RC, Graur F, Szold A, Couți R, Moldovan SC, Moiş E, Popa C, Pisla D, Vaida C, Tucan P, Al-Hajjar N. A 3D-Printed, High-Fidelity Pelvis Training Model: Cookbook Instructions and First Experience. J Clin Med 2024; 13:6416. [PMID: 39518556 PMCID: PMC11545952 DOI: 10.3390/jcm13216416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 10/18/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
Background: Since laparoscopic surgery became the gold standard for colorectal procedures, specific skills are required to achieve good outcomes. The best way to acquire basic and advanced skills and reach the learning curve plateau is by using dedicated simulators: box-trainers, video-trainers and virtual reality simulators. Laparoscopic skills training outside the operating room is cost-beneficial, faster and safer, and does not harm the patient. When compared to box-trainers, virtual reality simulators and cadaver models have no additional benefits. Several laparoscopic trainers available on the market as well as homemade box and video-trainers, most of them using plastic boxes and standard webcams, were described in the literature. The majority of them involve training on a flat surface without any anatomical environment. In addition to their demonstrated benefits, box-trainers which add anatomic details can improve the training quality and skills development of surgeons. Methods: We created a 3D-printed anatomic pelvi-trainer which offers a real-size narrow pelvic space environment for training. The model was created starting with a CT-scan performed on a female pelvis from the Anatomy Museum (Cluj-Napoca University of Medicine and Pharmacy, Romania), using Invesalius 3 software (Centro de Tecnologia da informação Renato Archer CTI, InVesalius open-source software, Campinas, Brazil) for segmentation, Fusion 360 with Netfabb software (Autodesk software company, Fusion 360 with Netfabb, San Francisco, CA, USA) for 3D modeling and a FDM technology 3D printer (Stratasys 3D printing company, Fortus 380mc 3D printer, Minneapolis, MN, USA). In addition, a metal mold for casting silicone valves was made for camera and endoscopic instruments ports. The trainer was tested and compared using a laparoscopic camera, a standard full HD webcam and "V-Box" (INTECH-Innovative Training Technologies, Milano, Italia), a dedicated hard paper box. The pelvi-trainer was tested by 33 surgeons with different qualifications and expertise. Results: We made a complete box-trainer with a versatile 3D-printed pelvi-trainer inside, designed for a wide range of basic and advanced laparoscopic skills training in the narrow pelvic space. We assessed the feedback of 33 surgeons regarding their experience using the anatomic 3D-printed pelvi-trainer for laparoscopic surgery training in the narrow pelvic space. Each surgeon tested the pelvi-trainer in three different setups: using a laparoscopic camera, using a webcam connected to a laptop and a "V-BOX" hard paper box. In the experiments that were performed, each participant completed a questionnaire regarding his/her experience using the pelvi-trainer. The results were positive, validating the device as a valid tool for training. Conclusions: We validated the anatomic pelvi-trainer designed by our team as a valuable alternative for basic and advanced laparoscopic surgery training outside the operating room for pelvic organs procedures, proving that it supports a much faster learning curve for colorectal procedures without harming the patients.
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Affiliation(s)
- Radu Claudiu Elisei
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.C.E.); (E.M.); (C.P.); (N.A.-H.)
- Emergency Clinical County Hospital, 420016 Bistrita, Romania; (R.C.); (S.C.M.)
| | - Florin Graur
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.C.E.); (E.M.); (C.P.); (N.A.-H.)
- “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400394 Cluj-Napoca, Romania
- CESTER Department, Faculty of Industrial Engineering, Robotics and Production Management, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.P.); (C.V.); (P.T.)
| | - Amir Szold
- Assia Medical, Assuta Medical Centre, Tel Aviv 6971028, Israel;
- Sheba Medical Centre and School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Răzvan Couți
- Emergency Clinical County Hospital, 420016 Bistrita, Romania; (R.C.); (S.C.M.)
| | | | - Emil Moiş
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.C.E.); (E.M.); (C.P.); (N.A.-H.)
- “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400394 Cluj-Napoca, Romania
- CESTER Department, Faculty of Industrial Engineering, Robotics and Production Management, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.P.); (C.V.); (P.T.)
| | - Călin Popa
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.C.E.); (E.M.); (C.P.); (N.A.-H.)
- “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400394 Cluj-Napoca, Romania
- CESTER Department, Faculty of Industrial Engineering, Robotics and Production Management, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.P.); (C.V.); (P.T.)
| | - Doina Pisla
- CESTER Department, Faculty of Industrial Engineering, Robotics and Production Management, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.P.); (C.V.); (P.T.)
| | - Calin Vaida
- CESTER Department, Faculty of Industrial Engineering, Robotics and Production Management, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.P.); (C.V.); (P.T.)
| | - Paul Tucan
- CESTER Department, Faculty of Industrial Engineering, Robotics and Production Management, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.P.); (C.V.); (P.T.)
| | - Nadim Al-Hajjar
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.C.E.); (E.M.); (C.P.); (N.A.-H.)
- “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400394 Cluj-Napoca, Romania
- CESTER Department, Faculty of Industrial Engineering, Robotics and Production Management, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.P.); (C.V.); (P.T.)
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Au KP, Chan MY, Chu KW, Kwan CLY, Ma KW, She WH, Tsang SHY, Dai WC, Cheung TT, Chan ACY. Impact of Three-Dimensional (3D) Visualization on Laparoscopic Hepatectomy for Hepatocellular Carcinoma. Ann Surg Oncol 2022; 29:6731-6744. [PMID: 35445336 DOI: 10.1245/s10434-022-11716-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The impact of three-dimensional (3D) visualization on laparoscopic hepatectomy for hepatocellular carcinoma is largely unknown. METHODS A retrospective review with propensity-score matched analysis of 3D and two-dimensional (2D) laparoscopic hepatectomy performed in a tertiary hepatobiliary surgery center. RESULTS Since the availability of 3D laparoscopy, the proportion of laparoscopic major hepatectomies has significantly expanded (1.7% vs. 24.0%, p < 0.0001) and the percentage of difficult resections among patients who underwent laparoscopic hepatectomy has also increased (12.6% vs. 40.0%, p = 0.0001). A total of 305 patients (92 in the 3D group and 213 in the 2D group) underwent laparoscopic hepatectomy between 2002 and 2019. The 3D group had better liver function, larger tumors at more difficult locations, more major resections, and more difficult surgeries. After propensity score matching, 144 patients were analyzed (72 in both the 3D and 2D groups). Patients were comparable in terms of liver status, tumor status, and complexity of liver surgery. Operative time (218 vs. 218 mins, p = 0.50) and blood loss (0.2 vs. 0.2L, p = 0.49) were comparable between the two groups, however overall complications were higher in the 2D group (1.4 vs. 11.1%, p = 0.03). Patients who underwent 3D laparoscopic major hepatectomy had a shorter hospital stay than their comparable counterparts operated through an open approach (7 vs. 6 days, p = 0.003). CONCLUSIONS 3D visualization enhanced the feasibility of laparoscopic major hepatectomy and difficult laparoscopic liver resection. 3D resection was potentially associated with fewer operative morbidities and the 3D laparoscopic approach did not jeopardize the outcome of major hepatectomy.
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Affiliation(s)
- Kin Pan Au
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Miu Yee Chan
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Ka Wan Chu
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Crystal Lok Yan Kwan
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Ka Wing Ma
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Wong Hoi She
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Simon Hing Yin Tsang
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Wing Chiu Dai
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Albert Chi Yan Chan
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
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Wang T, Zheng B. 3D presentation in surgery: a review of technology and adverse effects. J Robot Surg 2018; 13:363-370. [PMID: 30847653 DOI: 10.1007/s11701-018-00900-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/02/2018] [Indexed: 01/15/2023]
Abstract
A systematic review was undertaken to assess the technology used to create stereovision for human perception. Adverse effects associated with artificial stereoscopic technology were reviewed with an emphasis on the impact of surgical performance in the operating room. MEDLINE/PubMed library databases were used to identify literature published up to Aug 2017. In the past 60 years, four major types of technologies have been used for reconstructing stereo images: anaglyph, polarization, active shutter, and autostereoscopy. As none of them can perfectly duplicate our natural stereoperception, user exposure to this artificial environment for a period of time can lead to a series of psychophysiological responses including nausea, dizziness, and others. The exact mechanism underlying these symptoms is not clear. Neurophysiologic evidences suggest that the visuo-vestibular pathway plays a vital role in coupling unnatural visual inputs to autonomic neural responses. When stereoscopic technology was used in surgical environments, controversial results were reported. Although recent advances in stereoscopy are promising, no definitive evidence has yet been presented to support that stereoscopes can enhance surgical performance in image-guided surgery. Stereoscopic technology has been rapidly introduced to healthcare. Adverse effects to human operators caused by immature technology seem inevitable. The impact on surgeons working with this visualization system needs to be explored and its safety and feasibility need to be addressed.
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Affiliation(s)
- Tianqi Wang
- Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 162 Heritage Medical Research Centre, 112 St. NW, Edmonton, AB, T6G 2E1, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 162 Heritage Medical Research Centre, 112 St. NW, Edmonton, AB, T6G 2E1, Canada.
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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: 0.1] [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: 72] [Impact Index Per Article: 10.3] [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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Henn P, Gallagher AG, Nugent E, Seymour NE, Haluck RS, Hseino H, Traynor O, Neary PC. Visual spatial ability for surgical trainees: implications for learning endoscopic, laparoscopic surgery and other image-guided procedures. Surg Endosc 2018; 32:3634-3639. [DOI: 10.1007/s00464-018-6094-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 02/07/2018] [Indexed: 10/18/2022]
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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 2018; 163:300-304. [PMID: 29195739 DOI: 10.1016/j.surg.2017.09.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [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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Schwab K, Smith R, Brown V, Whyte M, Jourdan I. Evolution of stereoscopic imaging in surgery and recent advances. World J Gastrointest Endosc 2017; 9:368-377. [PMID: 28874957 PMCID: PMC5565502 DOI: 10.4253/wjge.v9.i8.368] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
In the late 1980s the first laparoscopic cholecystectomies were performed prompting a sudden rise in technological innovations as the benefits and feasibility of minimal access surgery became recognised. Monocular laparoscopes provided only two-dimensional (2D) viewing with reduced depth perception and contributed to an extended learning curve. Attention turned to producing a usable three-dimensional (3D) endoscopic view for surgeons; utilising different technologies for image capture and image projection. These evolving visual systems have been assessed in various research environments with conflicting outcomes of success and usability, and no overall consensus to their benefit. This review article aims to provide an explanation of the different types of technologies, summarise the published literature evaluating 3D vs 2D laparoscopy, to explain the conflicting outcomes, and discuss the current consensus view.
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The Conflicting Evidence of Three-dimensional Displays in Laparoscopy: A Review of Systems Old and New. Ann Surg 2016; 263:234-9. [PMID: 26501704 DOI: 10.1097/sla.0000000000001504] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe studies evaluating 3 generations of three-dimensional (3D) displays over the course of 20 years. SUMMARY BACKGROUND DATA Most previous studies have analyzed performance differences during 3D and two-dimensional (2D) laparoscopy without using appropriate controls that equated conditions in all respects except for 3D or 2D viewing. METHODS Databases search consisted of MEDLINE and PubMed. The reference lists for all relevant articles were also reviewed for additional articles. The search strategy employed the use of keywords "3D," "Laparoscopic," "Laparoscopy," "Performance," "Education," "Learning," and "Surgery" in appropriate combinations. RESULTS Our current understanding of the performance metrics between 3D and 2D laparoscopy is mostly from the research with flawed study designs. This review has been written in a qualitative style to explain in detail how prior research has underestimated the potential benefit of 3D displays and the improvements that must be made in future experiments comparing 3D and 2D displays to better determine any advantage of using one display or the other. CONCLUSIONS Individual laparoscopic performance in 3D may be affected by a multitude of factors. It is crucial for studies to measure participant stereoscopic ability, control for system crosstalk, and use validated measures of performance.
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Abstract
Minimally invasive surgery (MIS) poses visual challenges to the surgeons. In MIS, binocular disparity is not freely available for surgeons, who are required to mentally rebuild the 3-dimensional (3D) patient anatomy from a limited number of monoscopic visual cues. The insufficient depth cues from the MIS environment could cause surgeons to misjudge spatial depth, which could lead to performance errors thus jeopardizing patient safety. In this article, we will first discuss the natural human depth perception by exploring the main depth cues available for surgeons in open procedures. Subsequently, we will reveal what depth cues are lost in MIS and how surgeons compensate for the incomplete depth presentation. Next, we will further expand our knowledge by exploring some of the available solutions for improving depth presentation to surgeons. Here we will review the innovative approaches (multiple 2D camera assembly, shadow introduction) and devices (3D monitors, head-mounted devices, and auto-stereoscopic monitors) for 3D image presentation from the past few years.
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Affiliation(s)
| | | | - Bin Zheng
- University of Alberta, Edmonton, Alberta, Canada
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Egi H, Hattori M, Suzuki T, Sawada H, Kurita Y, Ohdan H. The usefulness of 3-dimensional endoscope systems in endoscopic surgery. Surg Endosc 2016; 30:4562-8. [PMID: 26895893 DOI: 10.1007/s00464-016-4793-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The image quality and performance of 3-dimensional video image systems has improved along with improvements in technology. However, objective evaluation on the usefulness of 3-dimensional video image systems is insufficient. Therefore, we decided to investigate the usefulness of 3-dimensional video image systems using the objective endoscopic surgery technology evaluating apparatus that we have developed, the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD). METHODS The participants were 28 student volunteers enrolled in Hiroshima University (17 men and 11 women, age: median 22.5, range 20-25), with no one having experienced endoscopic surgery training. Testing was carried out by dividing the subjects into two groups to initially carry out HUESAD with 2-dimensional video imaging (N = 14) and with 3-dimensional video imaging (N = 14). Questionnaires were carried out along with the investigation regarding both 2-dimensional and 3-dimensional video imaging. The task was carried out for approximately 15 min regarding both 2-dimensional and 3-dimensional video imaging. Lastly, the Mental Rotation Test, which is a standard space perception ability test, was used to evaluate the space perception ability. RESULTS No difference was observed in the nauseous and uncomfortable feeling of practitioners between the two groups. Regarding smoothness, no difference was observed between 2-dimensional and 3-dimensional video imaging (p = 0.8665). Deviation (space perception ability) and approaching time (accuracy) were significantly lower with 3-dimensional video imaging compared to 2-dimensional video imaging. Moreover, the approaching time (accuracy) significantly improved in 3-dimensional video imaging compared to 2-dimensional video imaging in the group with low space perception ability (p = 0.0085). CONCLUSION Objective evaluation using HUESAD and subjective evaluation by questionnaire revealed that endoscopic surgery techniques significantly improved in 3-dimensional video imaging compared to 2-dimensional video imaging. Moreover, it is believed that this effect is more effective in people with low space perception ability and beginner students.
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Affiliation(s)
- Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Minoru Hattori
- Advanced Medical Skills Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahisa Suzuki
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Sawada
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuichi Kurita
- Department of Artificial Complex Systems Engineering, Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Bove P, Iacovelli V, Celestino F, De Carlo F, Vespasiani G, Finazzi Agrò E. 3D vs 2D laparoscopic radical prostatectomy in organ-confined prostate cancer: comparison of operative data and pentafecta rates: a single cohort study. BMC Urol 2015; 15:12. [PMID: 25887253 PMCID: PMC4349673 DOI: 10.1186/s12894-015-0006-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/09/2015] [Indexed: 11/13/2022] Open
Abstract
Background Currently, men are younger at the time of diagnosis of prostate cancer and more interested in less invasive surgical approaches (traditional laparoscopy, 3D-laparoscopy, robotics). Outcomes of continence, erectile function, cancer cure, positive surgical margins and complication are well collected in the pentafecta rate. However, no comparative studies between 4th generation 3D-HD vision system laparoscopy and standard bi-dimensional laparoscopy have been reported. This study aimed to compare the operative, perioperative data and pentafecta rates between 2D and 3D laparoscopic radical prostatectomy (LRP) and to identify the actual role of 3D LRP in urology. Methods From October 2012 to July 2013, 86 patients with clinically localized prostate cancer [PCa: age ≤ 70 years, prostate-specific antigen (PSA) ≤ 10 ng/ml, biopsy Gleason score ≤ 7] underwent laparoscopic extraperitoneal radical prostatectomy (LERP) and were followed for approximately 14 months (range 12–25). Patients were selected for inclusion via hospital record data, and divided into two groups. Their patient records were then analyzed. Patients were randomized into two groups: the former 2D-LERP (43 pts) operated with the use of 2D-HD camera; the latter 3D-LERP (43 pts) operated with the use of a 3D-HD 4th generation view system. The operative and perioperative data and the pentafecta rates between 2D-LERP and 3D-LERP were compared. Results The overall pentafecta rates at 3 months were 47.4% and 49.6% in the 2D- and 3D-LERP group respectively. The pentafecta rate at 12 months was 62.7% and 67% for each group respectively. 4th generation 3D-HD vision system provides advantages over standard bi-dimensional view with regard to intraoperative steps. Our data suggest a trend of improvement in intraoperative blood loss and postoperative recovery of continence with the respect of the oncological safety. Conclusions Use of the 3D technology by a single surgeon significantly enhances the possibility of achieving better intraoperative results and pentafecta in all patients undergoing LERP. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. Nevertheless, further studies are necessary to better comprehend the role of 3D-LERP in modern urology.
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Affiliation(s)
- Pierluigi Bove
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Valerio Iacovelli
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Francesco Celestino
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Francesco De Carlo
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Giuseppe Vespasiani
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
| | - Enrico Finazzi Agrò
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, 00133, Rome, Italy.
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Brönnimann E, Hoffmann H, Schäfer J, Hahnloser D, Rosenthal R. Effect of different warm-up strategies on simulated laparoscopy performance: a randomized controlled trial. JOURNAL OF SURGICAL EDUCATION 2015; 72:96-103. [PMID: 25204231 DOI: 10.1016/j.jsurg.2014.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/04/2014] [Accepted: 07/27/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The objective of this trial was to assess which type of warm-up has the highest effect on virtual reality (VR) laparoscopy performance. The following warm-up strategies were applied: a hands-on exercise (group 1), a cognitive exercise (group 2), and no warm-up (control, group 3). DESIGN This is a 3-arm randomized controlled trial. SETTING The trial was conducted at the department of surgery of the University Hospital Basel in Switzerland. PARTICIPANTS A total of 94 participants, all laypersons without any surgical or VR experience, completed the study. RESULTS A total of 96 participants were randomized, 31 to group 1, 31 to group 2, and 32 to group 3. There were 2 postrandomization exclusions. In the multivariate analysis, we found no evidence that the intervention had an effect on VR performance as represented by 6 calculated subscores of accuracy, time, and path length for (1) camera manipulation and (2) hand-eye coordination combined with 2-handed maneuvers (p = 0.795). Neither the comparison of the average of the intervention groups (groups 1 and 2) vs control (group 3) nor the pairwise comparisons revealed any significant differences in VR performance, neither multivariate nor univariate. VR performance improved with increasing performance score in the cognitive exercise warm-up (iPad 3D puzzle) for accuracy, time, and path length in the camera navigation task. CONCLUSIONS We were unable to show an effect of the 2 tested warm-up strategies on VR performance in laypersons. We are currently designing a follow-up study including surgeons rather than laypersons with a longer warm-up exercise, which is more closely related to the final task.
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Affiliation(s)
- Enrico Brönnimann
- Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Henry Hoffmann
- Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland.
| | - Juliane Schäfer
- Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Rachel Rosenthal
- Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland
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15
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Kinoshita H, Nakagawa K, Usui Y, Iwamura M, Ito A, Miyajima A, Hoshi A, Arai Y, Baba S, Matsuda T. High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems. Surg Endosc 2014; 29:2203-9. [PMID: 25361650 DOI: 10.1007/s00464-014-3925-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/30/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Three-dimensional (3D) imaging systems have been introduced worldwide for surgical instrumentation. A difficulty of laparoscopic surgery involves converting two-dimensional (2D) images into 3D images and depth perception rearrangement. 3D imaging may remove the need for depth perception rearrangement and therefore have clinical benefits. METHODS We conducted a multicenter, open-label, randomized trial to compare the surgical outcome of 3D-high-definition (HD) resolution and 2D-HD imaging in laparoscopic radical prostatectomy (LRP), in order to determine whether an LRP under HD resolution 3D imaging is superior to that under HD resolution 2D imaging in perioperative outcome, feasibility, and fatigue. One-hundred twenty-two patients were randomly assigned to a 2D or 3D group. The primary outcome was time to perform vesicourethral anastomosis (VUA), which is technically demanding and may include a number of technical difficulties considered in laparoscopic surgeries. RESULTS VUA time was not significantly shorter in the 3D group (26.7 min, mean) compared with the 2D group (30.1 min, mean) (p = 0.11, Student's t test). However, experienced surgeons and 3D-HD imaging were independent predictors for shorter VUA times (p = 0.000, p = 0.014, multivariate logistic regression analysis). Total pneumoperitoneum time was not different. No conversion case from 3D to 2D or LRP to open RP was observed. Fatigue was evaluated by a simulation sickness questionnaire and critical flicker frequency. Results were not different between the two groups. Subjective feasibility and satisfaction scores were significantly higher in the 3D group. CONCLUSIONS Using a 3D imaging system in LRP may have only limited advantages in decreasing operation times over 2D imaging systems. However, the 3D system increased surgical feasibility and decreased surgeons' effort levels without inducing significant fatigue.
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Affiliation(s)
- Hidefumi Kinoshita
- Department Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan,
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Impact of examinees' stereopsis and near visual acuity on laparoscopic virtual reality performance. Surg Today 2014; 45:1280-90. [PMID: 25304827 DOI: 10.1007/s00595-014-1046-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 09/15/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Laparoscopic surgery represents specific challenges, such as the reduction of a three-dimensional anatomic environment to two dimensions. The aim of this study was to investigate the impact of the loss of the third dimension on laparoscopic virtual reality (VR) performance. METHODS We compared a group of examinees with impaired stereopsis (group 1, n = 28) to a group with accurate stereopsis (group 2, n = 29). The primary outcome was the difference between the mean total score (MTS) of all tasks taken together and the performance in task 3 (eye-hand coordination), which was a priori considered to be the most dependent on intact stereopsis. RESULTS The MTS and performance in task 3 tended to be slightly, but not significantly, better in group 2 than in group 1 [MTS: -0.12 (95 % CI -0.32, 0.08; p = 0.234); task 3: -0.09 (95 % CI -0.29, 0.11; p = 0.385)]. The difference of MTS between simulated impaired stereopsis between group 2 (by attaching an eye patch on the adominant eye in the 2nd run) and the first run of group 1 was not significant (MTS: p = 0.981; task 3: p = 0.527). CONCLUSION We were unable to demonstrate an impact of impaired examinees' stereopsis on laparoscopic VR performance. Individuals with accurate stereopsis seem to be able to compensate for the loss of the third dimension in laparoscopic VR simulations.
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Mashiach R, Mezhybovsky V, Nevler A, Gutman M, Ziv A, Khaikin M. Three-dimensional imaging improves surgical skill performance in a laparoscopic test model for both experienced and novice laparoscopic surgeons. Surg Endosc 2014; 28:3489-93. [DOI: 10.1007/s00464-014-3635-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/16/2014] [Indexed: 12/22/2022]
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Barkhoudarian G, Del Carmen Becerra Romero A, Laws ER. Evaluation of the 3-dimensional endoscope in transsphenoidal surgery. Neurosurgery 2014; 73:ons74-8; discussion ons78-9. [PMID: 23407288 DOI: 10.1227/neu.0b013e31828ba962] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Three-dimensional (3-D) endoscopy is a recent addition to augment the transsphenoidal surgical approach for anterior skull-base and parasellar lesions. We describe our experience implementing this technology into regular surgical practice. OBJECTIVE Retrospective review of clinical factors and outcomes. METHODS All patients were analyzed who had endoscopic endonasal parasellar operations since the introduction of the 3-D endoscope to our practice. Over an 18-month period, 160 operations were performed using solely endoscopic techniques. Sixty-five of these were with the Visionsense VSII 3-D endoscope and 95 utilized 2-dimensional (2-D) high-definition (HD) Storz endoscopes. Intraoperative and postoperative findings were analyzed in a retrospective fashion. RESULTS Comparing both groups, there was no significant difference in total or surgical operating room times comparing the 2-D HD and 3-D endoscopes (239 minutes vs 229 minutes, P = .47). Within disease-specific comparison, pituitary adenoma resection was significantly shorter utilizing the 3-D endoscope (surgical time 174 minutes vs 147 minutes, P = .03). These findings were independent of resident or fellow experience. There was no significant difference in the rate of complication, reoperation, tumor resection, or intraoperative cerebrospinal fluid leaks. Subjectively, the 3-D endoscope offered increased agility with 3-D techniques such as exposing the sphenoid rostrum, drilling sphenoidal septations, and identifying bony landmarks and suprasellar structures. CONCLUSION The 3-D endoscope is a useful alternative to the 2-D HD endoscope for transnasal anterior skull-base surgery. Preliminary results suggest it is more efficient surgically and has a shorter learning curve. As 3-D technology and resolution improve, it should serve to be an invaluable tool for neuroendoscopy.
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Affiliation(s)
- Garni Barkhoudarian
- Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
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Fluet MC, Lambercy O, Gassert R. Effects of 2D/3D visual feedback and visuomotor collocation on motor performance in a Virtual Peg Insertion Test. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:4776-9. [PMID: 23366996 DOI: 10.1109/embc.2012.6347035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper evaluates the influence of three different types of visual feedback on the motor performance of healthy subjects during the repeated execution of a Virtual Peg Insertion Test developed for the assessment of sensorimotor function of arm and hand in neurologically impaired subjects. One test trial consists of the grasping and insertion of 9 pegs into 9 holes using a haptic display with instrumented grasping handle. Three groups performed 10 trials initially on three different setups (group 1 with standard 2D visual feedback, group 2 with 3D, and group 3 with collocated 3D visual feedback) followed by 10 more trials with the setup with 2D visual feedback. The total execution time and the mean collision force as well as the time and the collision force for 6 different movement phases were compared between groups and analyzed in function of the number of repetitions. Results showed significantly lower time to approach and align the visual cursor with the peg with the 2D setup over the first 10 trials compared to the two other groups, suggesting limitations of the 3D setup. Furthermore, a significant decrease of the total execution time was found in the first 10 trials for all groups. For the 10 following trials, only group 3 showed a significant decrease in the total execution time, suggesting that the learning did not transfer to the 2D setup for this group.
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Wagner OJ, Hagen M, Kurmann A, Horgan S, Candinas D, Vorburger SA. Three-dimensional vision enhances task performance independently of the surgical method. Surg Endosc 2012; 26:2961-8. [PMID: 22580874 DOI: 10.1007/s00464-012-2295-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 04/02/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical skills and task performance. METHODS In this study, 34 individuals with varying laparoscopic experience (18 inexperienced individuals) performed three tasks to test spatial relationships, grasping and positioning, dexterity, precision, and hand-eye and hand-hand coordination. Each task was performed in 3D using binocular vision for open performance, the Viking 3Di Vision System for laparoscopic performance, and the DaVinci robotic system. The same tasks were repeated in 2D using an eye patch for monocular vision, conventional laparoscopy, and the DaVinci robotic system. RESULTS Loss of 3D vision significantly increased the perceived difficulty of a task and the time required to perform it, independently of the approach (P < 0.0001-0.02). Simple tasks took 25 % to 30 % longer to complete and more complex tasks took 75 % longer with 2D than with 3D vision. Only the difficult task was performed faster with the robot than with laparoscopy (P = 0.005). In every case, 3D robotic performance was superior to conventional laparoscopy (2D) (P < 0.001-0.015). CONCLUSIONS The more complex the task, the more 3D vision accelerates task completion compared with 2D vision. The gain in task performance is independent of the surgical method.
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Affiliation(s)
- O J Wagner
- Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
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An ergonomic analysis of the effects of camera rotation on laparoscopic performance. Surg Endosc 2012; 23:2684-91. [PMID: 19067048 DOI: 10.1007/s00464-008-0261-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 11/17/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Minimal access surgery is associated with increased risk of complications, particularly early in a surgeon's laparoscopic career. This is mostly due to loss of depth cues, degraded tactile feedback from surgical instrument, and the "fulcrum effect". Degraded and restricted image on the monitor makes camera orientation very important. The objective of this study is to investigate the effects of camera rotation on laparoscopic performance. METHODS In two separate studies 100 laparoscopic novices and 7 experienced laparoscopic surgeons ([300 laparoscopic procedures) were asked to perform a simple laparoscopic cutting task and tie intracorporeal square-knots (respectively) under 0, 15, 45, 90, and 180 camera rotation. RESULTS In study 1 camera rotation significantly degraded performance of laparoscopic novices (p\0.00001) and also increased their error rate (p\0.00001). In study 2 camera rotation significantly increased the length of time it took surgeons to tie an intracorporeal square-knot (p\0.00001) and the number of errors made (p\0.0001). CONCLUSIONS Unintentional camera rotation during surgery should be avoided to eliminate one potential source for errors.
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van Beurden MHPH, IJsselsteijn WA, Juola JF. Effectiveness of stereoscopic displays in medicine: A review. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/3dres.01(2012)3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Feng C, Rozenblit JW, Hamilton AJ. A computerized assessment to compare the impact of standard, stereoscopic, and high-definition laparoscopic monitor displays on surgical technique. Surg Endosc 2010; 24:2743-8. [PMID: 20361211 DOI: 10.1007/s00464-010-1038-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 03/11/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND Surgeons performing laparoscopic surgery have strong biases regarding the quality and nature of the laparoscopic video monitor display. In a comparative study, we used a unique computerized sensing and analysis system to evaluate the various types of monitors employed in laparoscopic surgery. METHODS We compared the impact of different types of monitor displays on an individual's performance of a laparoscopic training task which required the subject to move the instrument to a set of targets. Participants (varying from no laparoscopic experience to board-certified surgeons) were asked to perform the assigned task while using all three display systems, which were randomly assigned: a conventional laparoscopic monitor system (2D), a high-definition monitor system (HD), and a stereoscopic display (3D). The effects of monitor system on various performance parameters (total time consumed to finish the task, average speed, and movement economy) were analyzed by computer. Each of the subjects filled out a subjective questionnaire at the end of their training session. RESULTS A total of 27 participants completed our study. Performance with the HD monitor was significantly slower than with either the 3D or 2D monitor (p < 0.0001). Movement economy with the HD monitor was significantly reduced compared with the 3D (p < 0.0004) or 2D (p < 0.0001) monitor. In terms of average time required to complete the task, performance with the 3D monitor was significantly faster than with the HD (p < 0.0001) or 2D (p < 0.0086) monitor. However, the HD system was the overwhelming favorite according to subjective evaluation. CONCLUSION Computerized sensing and analysis is capable of quantitatively assessing the seemingly minor effect of monitor display on surgical training performance. The study demonstrates that, while users expressed a decided preference for HD systems, actual quantitative analysis indicates that HD monitors offer no statistically significant advantage and may even worsen performance compared with standard 2D or 3D laparoscopic monitors.
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Affiliation(s)
- Chuan Feng
- Department of Electrical and Computer Engineering and Arizona Simulation Technology and Education Center, University of Arizona, Tucson, AZ 85721, USA.
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Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera. Surg Endosc 2009; 24:1132-43. [PMID: 19911222 DOI: 10.1007/s00464-009-0740-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 10/12/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study evaluated the effects of a three-dimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system. METHODS In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles. RESULTS The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system. CONCLUSION The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery.
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Zheng B, Cassera MA, Martinec DV, Spaun GO, Swanström LL. Measuring mental workload during the performance of advanced laparoscopic tasks. Surg Endosc 2009; 24:45-50. [DOI: 10.1007/s00464-009-0522-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/06/2009] [Accepted: 04/20/2009] [Indexed: 11/30/2022]
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Bittner JG, Hathaway CA, Brown JA. Three-dimensional visualisation and articulating instrumentation: Impact on simulated laparoscopic tasks. J Minim Access Surg 2008; 4:31-8. [PMID: 19547678 PMCID: PMC2699064 DOI: 10.4103/0972-9941.41938] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 02/18/2008] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED Laparoscopy requires the development of technical skills distinct from those used in open procedures. Several factors extending the learning curve of laparoscopy include ergonomic and technical difficulties, such as the fulcrum effect and limited degrees of freedom. This study aimed to establish the impact of four variables on performance of two simulated laparoscopic tasks. METHODS Six subjects including novice (n=2), intermediate (n=2) and expert surgeons completed two tasks: 1) four running sutures, 2) simple suture followed by surgeon's knot plus four square knots. Task variables were suturing angle (left/right), needle holder type (standard/articulating) and visualisation (2D/3D). Each task with a given set of variables was completed twice in random order. The endpoints included suturing task completion time, average and maximum distance from marks and knot tying task completion time. RESULTS Suturing task completion time was prolonged by 45-degree right angle suturing, articulating needle holder use and lower skill levels (all P < 0.0001). Accuracy also decreased with articulating needle holder use (both P < 0.0001). 3D vision affected only maximum distance (P=0.0108). For the knot tying task, completion time was greater with 45-degree right angle suturing (P=0.0015), articulating needle holder use (P < 0.0001), 3D vision (P=0.0014) and novice skill level (P=0.0003). Participants felt that 3D visualisation offered subjective advantages during training. CONCLUSIONS Results suggest construct validity. A 3D personal head display and articulating needle holder do not immediately improve task completion times or accuracy and may increase the training burden of laparoscopic suturing and knot tying.
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Affiliation(s)
- James G Bittner
- Virtual Education and Surgical Simulation Laboratory (VESSL), Medical College of Georgia School of Medicine, Augusta, Georgia, USA
| | - Christopher A Hathaway
- Section of Urology, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia, USA
| | - James A Brown
- Section of Urology, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia, USA
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Abstract
BACKGROUND Simulators are being used to teach laparoscopic skills before residents get to the operating room. It is unknown whether the use of three-dimensional (3D) vision will facilitate laparoscopic training. Therefore, our objective was to compare the effectiveness of using 3D imaging over the traditional two-dimensional (2D) imaging to teach laparoscopic simulator skills to novice individuals and assess whether 3D imaging ameliorates laparoscopic performance for surgeons who have already adapted to working within a 2D surgical environment. METHODS This prospective study involved 36 surgical residents and students. Inexperienced participants included medical students and first- and second-year surgical residents (n = 25). Experienced participants included third- and fifth-year surgical residents (n = 11). Participants were tested on six laparoscopic skills using 2D or 3D imaging systems and then retested about 3 months later using the opposing imaging system. Evaluation of performance was based on the time elapsed to task completion and the errors committed during that time. RESULTS The experienced participants performed better than the inexperienced participants regardless of the imaging system. Inexperienced participants initially tested using 2D imaging required significantly more time and/or made more errors to complete five of the six laparoscopic tasks compared to those initially tested using 3D imaging (p < 0.05). After initial testing on 3D imaging, inexperienced participants retested using 2D imaging performed significantly better on five of six tasks compared to the scores of inexperienced participants initially tested on 2D imaging (p < 0.05). In contrast, the inexperienced participants' retested on 3D after initial 2D imaging did not improve on any laparoscopic task compared to the scores of inexperienced participants initially tested on 3D imaging. Among the experienced participants, no significant difference in time or errors to task completion was observed under 2D imaging compared to 3D imaging during the first or second testing session. CONCLUSIONS Our study indicates that 3D imaging offers significant advantages in the teaching of laparoscopic skills to inexperienced individuals.
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Aggarwal R, Grantcharov T, Moorthy K, Milland T, Papasavas P, Dosis A, Bello F, Darzi A. An evaluation of the feasibility, validity, and reliability of laparoscopic skills assessment in the operating room. Ann Surg 2007; 245:992-9. [PMID: 17522527 PMCID: PMC1876956 DOI: 10.1097/01.sla.0000262780.17950.e5] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room. SUMMARY BACKGROUND DATA The assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the validity, reliability, and feasibility of any tool to be applied for objective measurement of performance. METHODS Nineteen subjects, divided into 13 experienced (performed >100 laparoscopic cholecystectomies) and 6 inexperienced (performed <10 LCs) surgeons completed LCs on 53 patients who all had a diagnosis of biliary colic. Each procedure was recorded with the ROVIMAS video-based motion tracking device to provide an objective measure of the surgeon's dexterity. Each video was also rated by 2 experienced observers on a previously validated operative assessment scale. RESULTS There were significant differences for motion tracking parameters between the 2 groups of surgeons for the Calot triangle dissection part of procedure for time taken (P = 0.002), total path length (P = 0.026), and number of movements (P = 0.005). Both motion tracking and video-based assessment displayed intertest reliability, and there were good correlations between the 2 modes of assessment (r = 0.4 to 0.7, P < 0.01). CONCLUSIONS An instant, objective, valid, and reliable mode of assessment of laparoscopic performance in the operating room has been defined. This may serve to reduce the time taken for technical skills assessment, and subsequently lead to accurate and efficient audit and credentialing of surgeons for independent practice.
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Affiliation(s)
- Rajesh Aggarwal
- Department of Biosurgery & Surgical Technology, Imperial College London, St. Mary's Hospital, Praed Street, London, UK.
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Mohamed A, Rafiq A, Panait L, Lavrentyev V, Doarn CR, Merrell RC. Skill performance in open videoscopic surgery. Surg Endosc 2006; 20:1281-5. [PMID: 16865617 DOI: 10.1007/s00464-005-0696-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 02/23/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Application of minimally invasive surgery represents the future of modern surgical care. Previous studies by our group provided a novel way for viewing open surgery using a rigid endoscope attached to charged coupled device (CCD) camera in proximity to the surgical field using a robotic arm (AESOP) and a stabilizing fulcrum (Alpha port). MATERIALS AND METHODS This study is a follow-up to investigate the technical feasibility, advantages, and disadvantages of relying only on video images displayed on standard monitors in performing open surgical procedures instead of direct binocular eye vision. This study used two surgeons as participants with training in basic surgical skill and previous experience in performing an intestinal anastomosis in an ordinary fashion. The standard task consisted of anastomosing porcine intestine in two layers with digital viewing of the operative field. A total of 40 anastomoses (20 by each surgeon) were compared with 10 control performances using direct vision of the field. RESULTS All the resulting anastomoses were accurate, well coapted, and fully patent with no leakage. Time for task performance was approximately twice as long (p < 0.05) with videoscopic vision as with direct vision. DISCUSSION These findings suggest it is technically feasible to conduct open surgeries with visualization of the open surgical field limited to video display on standard monitors.
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Affiliation(s)
- A Mohamed
- Medical Informatics and Technology Applications Consortium, Department of Surgery, Virginia Commonwealth University, P.O. Box 980480, 1101 E. Marshall Street, Richmond, VA 23298, USA
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Panait L, Rafiq A, Mohamed A, Doarn C, Merrell RC. Surgical skill facilitation in videoscopic open surgery. J Laparoendosc Adv Surg Tech A 2004; 13:387-95. [PMID: 14733703 DOI: 10.1089/109264203322656469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The operating room (OR) was traditionally characterized as a closed environment, in which the view of the operative field was available to the surgeon and assistant only. In laparoscopy, integration of technology into the surgical theatre has transformed surgical procedures into minimally invasive events, with viewing of the surgical field using endoscopic cameras. Similar technical advances to the open surgical environment will allow visualization and coordination of finer surgical maneuvers on standard video monitors. The objective of this study was to develop optimal protocols for performing basic open surgical maneuvers without direct viewing of the operating field, instead watching a monitor that displays the image of the surgical field captured by an endoscopic camera. The AESOP robotic arm and Alpha Virtual Port (Computer Motion, Goleta, California) were used to hold the endoscopic camera in different positions relative to the surgeon and the operative table. The surgeons conducting the study evaluated six such different setups. Based on the average time to complete the task in each of these setups and the ease of adaptation to the new working conditions, we concluded that at least one of these setups could be translated into the OR. The advantages of integrating video image enhancement over classical open surgery (OS) are that the surgical field can be magnified to perform finer maneuvers, and to share views of the surgical field with additional clinicians and trainees.
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Affiliation(s)
- Lucian Panait
- Medical Informatics and Technology Applications Consortium, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
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Rafiq A, Moore JA, Zhao X, Doarn CR, Merrell RC. Digital video capture and synchronous consultation in open surgery. Ann Surg 2004; 239:567-73. [PMID: 15024319 PMCID: PMC1356263 DOI: 10.1097/01.sla.0000118749.24645.45] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To achieve real-time or simultaneous surgical consultation and education to students in distant locations, we report the successful integration of robotics, video-teleconferencing, and intranet transmission using currently available hardware and Internet capabilities. SUMMARY BACKGROUND DATA Accurate visualization of the surgical field with high-resolution video imaging cameras such as the closed-coupled device (CCD) of the laparoscope can serve to insure clear visual observation of surgery and share the surgical procedure with trainees and, or consultants in a distant location. Prior work has successfully applied optics and technical advances to achieve precise visualization in laparoscopy. METHODS Twenty-five thyroidectomy explorations in 15 patients were monitored and transmitted bidirectionally with audio and video data in real-time. Remotely located surgical trainees (n = 4) and medical students (n = 3) confirmed 7 different anatomic landmarks during each surgical procedure. The study used the Socrates System (Computer Motion, Inc. [CMI], Goleta, CA), an interactive telementoring system inclusive of a telestration whiteboard, in conjunction with the AESOP robotic arm and Hermes voice command system (CMI). A 10-mm flat laparoscopic telescope was used to capture the optical surgical field. As voice, telestrator, or marker confirmed each anatomic landmark the image parameters of resolution, chroma (light position and intensity), and luminance were assessed with survey responses. RESULTS Confirmation of greater than 90% was achieved for the majority of relevant anatomic landmarks, which were viewed by the remote audience. CONCLUSION The data presented in this study support the feasibility for mentoring and consultation to a remote audience with visual transmission of the surgical field, which is otherwise very difficult to share. Additionally, validation of technical protocols as teaching tools for robotic instrumentation and computer imaging of surgical fields was documented.
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Affiliation(s)
- Azhar Rafiq
- Medical Informatics and Technology Applications Consortium, Department of Surgery, Virginia Commonwealth University, Richmond 23298, USA.
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Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F, Rockall T, Darzi A. Dexterity enhancement with robotic surgery. Surg Endosc 2004; 18:790-5. [PMID: 15216862 DOI: 10.1007/s00464-003-8922-2] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2003] [Accepted: 12/18/2003] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to quantify the extent of dexterity enhancement in robotic surgery as compared to laparoscopic surgery. METHODS Ten surgeons with varying laparoscopic suturing experience were asked to place three sutures on a suture pad. The sutures were placed laparoscopically, robotically with 2-D vision and robotically with 3-D vision. The da Vinci systems Application Programming Interface (API) was used for positional data. A validated motion analysis system was used for data retrieval for the laparoscopic task. Custom software was developed for data analysis. RESULTS Compared to laparoscopic suturing, when the task was undertaken robotically with 2-D vision there was a 20% reduction in the time taken but this was not significant (p = 0.07). There was a 55% reduction in the path traveled by the right hand (p = 0.01) and a 45% reduction in the path traveled by the left hand (p = 0.008). When the task was undertaken robotically with 3-D vision, there was a 40% reduction in the time taken (p = 0.01). There was a 70% reduction in the path traveled by right hand (p = 0.008) and a 55% reduction by the left hand (p = 0.08). CONCLUSIONS The presence of wristed instrumentation, tremor abolition, and motion scaling enhance dexterity by nearly 50% as compared to laparoscopic surgery. 3-D vision enhances dexterity by a further 10-15%. In addition, the presence of 3-D vision results in a 93% reduction in skills-based errors.
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Affiliation(s)
- K Moorthy
- Department of Surgical Oncology and Technology, Imperial College, 10th Floor, QEQM Building, St. Marys Hospital, Praed Street, W2 1NY, London.
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Munz Y, Moorthy K, Dosis A, Hernandez JD, Bann S, Bello F, Martin S, Darzi A, Rockall T. The benefits of stereoscopic vision in robotic-assisted performance on bench models. Surg Endosc 2004; 18:611-6. [PMID: 14752629 DOI: 10.1007/s00464-003-9017-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2003] [Accepted: 08/22/2003] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous studies have failed to establish clear advantages for the use of stereoscopic visualization systems in minimal-access surgery. The aim of this study was to objectively assess whether stereoscopic visualization improves performance on bench models using the da Vinci robotic system. METHODS Eleven surgeons carried out a series of four tasks. Positional data streamed from the da Vinci system was analyzed by means of a previously validated custom-designed software-package. An independent blinded observer scored errors. Statistical analysis included the Wilcoxon signed rank test. A p < 0.05 was deemed significant. RESULTS We found significant improvements in all tasks and for all parameters (p < 0.05). In addition, a significantly lower number of errors was scored using the stereoscopic mode as compared to the standard two-dimensional image (p < 0.001). CONCLUSION Robotic-assisted performance on bench models is more efficient and accurate using stereoscopic visualization.
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Affiliation(s)
- Y Munz
- Department of Surgical Oncology and Technology, Imperial College London, St. Mary's Hospital, London, England, United Kingdom.
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LiteratureWatch. J Laparoendosc Adv Surg Tech A 2000; 10:293-5. [PMID: 11071412 DOI: 10.1089/lap.2000.10.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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