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Trute RJ, Alijani A, Erden MS. Visual cues of soft-tissue behaviour in minimal-invasive and robotic surgery. J Robot Surg 2024; 18:401. [PMID: 39508918 PMCID: PMC11543711 DOI: 10.1007/s11701-024-02150-y] [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: 08/23/2024] [Accepted: 10/20/2024] [Indexed: 11/15/2024]
Abstract
Minimal-invasive surgery (MIS) and robotic surgery (RS) offer multiple advantages over open surgery (Vajsbaher et al. in Cogn Syst Res 64:08, 2020). However, the lack of haptic feedback is still a limitation. Surgeons learn to adapt to this lack of haptic feedback using visual cues to make judgements about tissue deformation. Experienced robotic surgeons use the visual interpretation of tissue as a surrogate for tactile feedback. The aim of this review is to identify the visual cues that are consciously or unconsciously used by expert surgeons to manipulate soft tissue safely during Minimally Invasive Surgery (MIS) and Robotic Surgery (RS). We have conducted a comprehensive literature review with papers on visual cue identification and their application in education, as well as skill assessment and surgeon performance measurement with respect to visual feedback. To visualise our results, we provide an overview of the state-of-the-art in the form of a matrix across identified research features, where papers are clustered and grouped in a comparative way. The clustering of the papers showed explicitly that state-of-the-art research does not in particular study the direct effects of visual cues in relation to the manipulation of the tissue and training for that purpose, but is more concentrated on tissue identification. We identified a gap in the literature about the use of visual cues for educational design solutions, that aid the training of soft-tissue manipulation in MIS and in RS. There appears to be a need RS education to make visual cue identification more accessible and set it in the context of manipulation tasks.
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Affiliation(s)
- Robin Julia Trute
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
- Edinburgh Centre for Robotics, Edinburgh, UK
| | | | - Mustafa Suphi Erden
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK.
- Edinburgh Centre for Robotics, Edinburgh, UK.
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Amiri R, Zwart MJW, Jones LR, Abu Hilal M, Beerlage HP, van Berge Henegouwen MI, Lameris WW, Bemelman WA, Besselink MG. Surgeon Preference and Clinical Outcome of 3D Vision Compared to 2D Vision in Laparoscopic Surgery: Systematic Review and Meta-Analysis of Randomized Trials. ANNALS OF SURGERY OPEN 2024; 5:e415. [PMID: 38911624 PMCID: PMC11191999 DOI: 10.1097/as9.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To assess the added value of 3-dimensional (3D) vision, including high definition (HD) technology, in laparoscopic surgery in terms of surgeon preference and clinical outcome. Background The use of 3D vision in laparoscopic surgery has been suggested to improve surgical performance. However, the added value of 3D vision remains unclear as a systematic review of randomized controlled trials (RCTs) comparing 3D vision including HD technology in laparoscopic surgery is currently lacking. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines with a literature search up to May 2023 using PubMed and Embase (PROSPERO, CRD42021290426). We included RCTs comparing 3D versus 2-dimensional (2D) vision in laparoscopic surgery. The primary outcome was operative time. Meta-analyses were performed using the random effects model to estimate the pooled effect size expressed in standard mean difference (SMD) with corresponding 95% confidence intervals (CIs). The level of evidence and quality was assessed according to the Cochrane risk of bias tool. Results Overall, 25 RCTs with 3003 patients were included. Operative time was reduced by 3D vision (-8.0%; SMD, -0.22; 95% CI, -0.37 to -0.06; P = 0.007; n = 3003; 24 studies; I 2 = 75%) compared to 2D vision. This benefit was mostly seen in bariatric surgery (-16.3%; 95% CI, -1.28 to -0.21; P = 0.006; 2 studies; n = 58; I 2 = 0%) and general surgery (-6.7%; 95% CI, -0.34 to -0.01; P = 0.036; 9 studies; n = 1056; I 2 = 41%). Blood loss was nonsignificantly reduced by 3D vision (SMD, -0.33; 95% CI, -0.68 to 0.017; P = 0.060; n = 1830; I 2 = 92%). No differences in the rates of morbidity (14.9% vs 13.5%, P = 0.644), mortality (0% vs 0%), conversion (0.8% vs 0.9%, P = 0.898), and hospital stay (9.6 vs 10.5 days, P = 0.078) were found between 3D and 2D vision. In 15 RCTs that reported on surgeon preference, 13 (87%) reported that the majority of surgeons favored 3D vision. Conclusions Across 25 RCTs, this systematic review and meta-analysis demonstrated shorter operative time with 3D vision in laparoscopic surgery, without differences in other outcomes. The majority of surgeons participating in the RCTs reported in favor of 3D vision.
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Affiliation(s)
- Rawin Amiri
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Maurice J. W. Zwart
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Leia R. Jones
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Harrie P. Beerlage
- Cancer Center Amsterdam, Netherlands
- Department of Urology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Mark I. van Berge Henegouwen
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Wytze W. Lameris
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Willem A. Bemelman
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
| | - Marc G. Besselink
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Netherlands
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Hidding J, Bucher J, Heiliger C, Andrade D, Trupka L, Halmen M, Werner J, Karcz K, Frank A. Laparoscopy training of novices with complex curved instruments using 2D- and 3D-visualization. Langenbecks Arch Surg 2024; 409:109. [PMID: 38570339 PMCID: PMC10990991 DOI: 10.1007/s00423-024-03297-w] [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: 08/25/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Beside many advantages, disadvantages such as reduced degrees of freedom and poorer depth perception are still apparent in laparoscopic surgery. 3D visualization and the development of complex instruments are intended to counteract the disadvantages. We want to find out whether the use of complex instruments and 3D visualization has an influence on the performance of novices. METHODS 48 medical students with no experience in laparoscopic surgery or simulator-based laparoscopy training were included. They were randomized in four groups according to a stratification assessment. During a structured training period they completed the FLS-Tasks "PEG Transfer", "Pattern Cut" and "Intracorporeal Suture" and a transfer task based on these three. Two groups used conventional laparoscopic instruments with 3D or 2D visualization, two groups used complex curved instruments. The groups were compared in terms of their performance. RESULTS In 2D laparoscopy there was a better performance with straight instruments vs. curved instruments in PEG Transfer and Intracorporeal Suture. In the transfer task, fewer errors were made with straight instruments. In 2D vs. 3D laparoscopy when using complex curved instruments there was an advantage in Intracorporeal Suture and PEG Transfer for 3D visualization. Regarding the transfer exercise, a better performance was observed and fewer errors were made in 3D group. CONCLUSION We could show that learning laparoscopic techniques with complex curved instruments is more difficult with standard 2D visualization and can be overcome using 3D optics. The use of curved instruments under 3D vision seems to be advantageous when working on more difficult tasks.
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Affiliation(s)
- Johanna Hidding
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - Julian Bucher
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Heiliger
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Dorian Andrade
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Lukas Trupka
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Halmen
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Konrad Karcz
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Frank
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
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Tercan C, Sivas MC, Aktoz F. The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study. Arch Gynecol Obstet 2024; 309:1027-1033. [PMID: 38184803 DOI: 10.1007/s00404-023-07335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE 2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. METHODS In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. RESULTS The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). CONCLUSION In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.
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Affiliation(s)
- Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Mustafa Can Sivas
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Fatih Aktoz
- Women's Health Center, American Hospital, Istanbul, Turkey
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Brollo PP, Bresadola V. Enhancing visualization and guidance in general surgery: a comprehensive and narrative review of the current cutting-edge technologies and future perspectives. J Gastrointest Surg 2024; 28:179-185. [PMID: 38445941 DOI: 10.1016/j.gassur.2023.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND In the last decade, there has been a great effort in developing new technologies to enhance surgical visualization and guidance. This comprehensive and narrative review aimed to provide a wide and extensive overview of the current state of the art on this topic and their near-future perspectives linked to the development of artificial intelligence (AI), by focusing on the most recent and relevant literature. METHODS A comprehensive and narrative review of the literature was performed by searching specific terms on PubMed/MEDLINE, Scopus, and Embase databases, assessing the current state of the art on this topic. RESULTS Fluorescence-guided surgery, contrast-enhanced ultrasound (CEUS), ultra-high frequency ultrasound (UHFUS), photoacoustic imaging (PAI), and augmented reality (AR) are boosting the field of image-guided techniques as the rapid development of AI in surgery is promising a more automated decision-making and surgical movements in the operating room. CONCLUSION Fluorescence-guided surgery, CEUS, UHFUS, PAI, and AR are becoming crucial to give surgeons a new level of information during the intervention, with the right timing and sequence, and represent the future of surgery. As many more controlled studies are needed to validate the employment of these technologies, the next generation of surgeons must become more familiar with the basics of AI to better incorporate new tools into the daily surgical practice of the future.
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Affiliation(s)
- Pier Paolo Brollo
- Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy; General Surgical Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico di Aviano (Istituto Nazionale Tumori), Aviano, Italy.
| | - Vittorio Bresadola
- Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy
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Ahmad MA, Weiler Y, Joyeux L, Eixarch E, Vercauteren T, Ourselin S, Deprest J, Vander Poorten E. 3D vs. 2D simulated fetoscopy for spina bifida repair: a quantitative motion analysis. Sci Rep 2023; 13:20951. [PMID: 38016964 PMCID: PMC10684542 DOI: 10.1038/s41598-023-47531-9] [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: 02/19/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
3D imaging technology is becoming more prominent every day. However, more validation is needed to understand the actual benefit of 3D versus conventional 2D vision. This work quantitatively investigates whether experts benefit from 3D vision during minimally invasive fetoscopic spina bifida (fSB) repair. A superiority study was designed involving one expert team ([Formula: see text] procedures prior) who performed six 2D and six 3D fSB repair simulations in a high-fidelity animal training model, using 3-port access. The 6D motion of the instruments was recorded. Among the motion metrics are total path length, smoothness, maximum speed, the modified Spectral Arc Length (SPARC), and Log Dimensionless Jerk (LDLJ). The primary clinical outcome is operation time (power 90%, 5% significance) using Sealed Envelope Ltd. 2012. Secondary clinical outcomes are water tightness of the repair, CO[Formula: see text] insufflation volume, and OSATS score. Findings show that total path length and LDLJ are considerably different. Operation time during 3D vision was found to be significantly shorter compared to 2D vision ([Formula: see text] vs. [Formula: see text] min; p [Formula: see text] 0.026). These results suggest enhanced performance with 3D vision during interrupted suturing in fetoscopic SBA repair. To confirm these results, a larger-scale follow-up study involving multiple experts and novice surgeons is recommended.
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Affiliation(s)
- Mirza Awais Ahmad
- Department of Mechanical Engineering Sciences, Catholic University of Leuven, 3000, Leuven, Belgium.
- Obstetrics and Gynaecology, University Hospital of Leuven, 3000, Leuven, Belgium.
| | - Yolan Weiler
- Department of Mechanical Engineering Sciences, Catholic University of Leuven, 3000, Leuven, Belgium
| | - Luc Joyeux
- Obstetrics and Gynaecology, University Hospital of Leuven, 3000, Leuven, Belgium
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Hospital Clinic, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Tom Vercauteren
- Department of Imaging and Biomedical Engineering, Kings College, London, WC2R 2LS, UK
| | - Sebastien Ourselin
- Department of Imaging and Biomedical Engineering, Kings College, London, WC2R 2LS, UK
| | - Jan Deprest
- Obstetrics and Gynaecology, University Hospital of Leuven, 3000, Leuven, Belgium
| | - Emmanuel Vander Poorten
- Department of Mechanical Engineering Sciences, Catholic University of Leuven, 3000, Leuven, Belgium
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Bao T, Wang YJ, Li KK, Zhao XL, Liu B, He XD, Xie XF, Zhang L, Li KL, Guo W. Safety and feasibility of three-dimensional McKeown minimally invasive esophagectomy. Surg Endosc 2023; 37:6908-6914. [PMID: 37322359 DOI: 10.1007/s00464-023-10172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/30/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND To compare the perioperative outcomes from McKeown minimally invasive esophagectomy (MIE) when performed in three-dimensional versus two-dimensional visualization system, and investigate the learning curve of a single surgeon who implemented three-dimensional McKeown MIE. METHODS A total of 335 consecutive cases (three-dimensional or two-dimensional) were identified. Perioperative clinical parameters were compared and cumulative sum learning curve was plotted. Propensity score matching was used to reduce selection bias from confounding factors. RESULTS Patients in three-dimensional group were associated with more chronic obstructive pulmonary disease (23.9% vs 3.0%, p < 0.01). After propensity score matching (108 matched patients in each groups), this finding was no longer statistically significant. Comparing to two-dimensional group, significant improvement in total retrieved lymph nodes (28 vs 33, p = 0.003) was observed in three-dimensional group. In addition, more lymph nodes around the right recurrent laryngeal nerve were harvested in three-dimensional group than that in two-dimensional group (p = 0.045). However, there were no significantly differences were found between the two groups in terms of other intraoperative parameters (e.g., operative time) and postoperative relevant outcomes (e.g., lung infection). Furthermore, the change point in the cumulative sum learning curves for intraoperative blood loss and thoracic procedure time was 33 procedures, respectively. CONCLUSION Three-dimensional visualization system appears to be superior in performing lymphadenectomy during McKeown MIE to that of a two-dimensional technique. For surgeons proficient in performing two-dimensional McKeown MIE, the learning curve for a three-dimensional procedure appears to begin near proficiency after more than 33 cases.
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Affiliation(s)
- Tao Bao
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Ying-Jian Wang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Kun-Kun Li
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Xiao-Long Zhao
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Bi Liu
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Xian-Dong He
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Xian-Feng Xie
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Liang Zhang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Kun-Lin Li
- Department of Respiration, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China.
| | - Wei Guo
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China.
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Chan KS, Shelat VG. Three-Dimensional Versus Two-Dimensional Laparoscopy in Laparoscopic Liver Resection: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:678-690. [PMID: 37057963 DOI: 10.1089/lap.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background: Three-dimensional (3D) laparoscopy provides stereopsis and may reduce operating time (OT) and morbidity. However, there is a paucity of literature on its use in laparoscopic liver resection (LLR). This study aims to compare outcomes between 3D and two-dimensional (2D) LLR. Materials and Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched from inception to November 2022. The inclusion criterion was studies comparing intraoperative characteristics and/or postoperative outcomes between 3D and 2D LLR. Studies on the use of 3D image reconstruction techniques for preoperative planning were excluded. Primary outcomes were OT, estimated blood loss (EBL), and overall morbidity. Secondary outcomes were other postoperative complications, need for reoperation, and in-hospital mortality. Results: Four studies with 361 patients (3D: n = 159, 2D: n = 202) were included. There were 65.3% males (overall: n = 236/361). Age, sex, body-mass index, incidence of diabetes mellitus, hepatitis B and/or C carrier, receipt of neoadjuvant chemotherapy, tumor size, and incidence of multiple tumors were comparable between 3D and 2D LLR. No studies reported on Child-Pugh status. One study included only patients with hepatocellular carcinoma, two studies included patients with mixed histopathology, and one study did not report on histopathology. There was no significant difference in OT (mean difference [MD] -31.6 minutes, 95% confidence interval [CI]: -89.7 to 26.5), EBL (MD -454.1 mL, 95% CI: -978.8 to 70.6), need for reoperation (odds ratio [OR] 0.91, 95% CI: 0.18-4.61), and in-hospital mortality (OR 0.52, 95% CI: 0.06-5.50) between 3D and 2D LLR. Overall morbidity was lower in 3D LLR (OR 0.56, 95% CI: 0.32-0.98, P = .04). However, the learning curve (LC) was not described in the included studies and may confound outcomes. Conclusions: 3D LLR may reduce overall postoperative morbidity compared with 2D LLR, but results may be confounded by the lack of standardization of surgeons' experience and the LC of 3D LLR.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Wensheg L, Shunrong J, Wenyan X, Yihua S, Mengqi L, Zheng L, Qifeng Z, Xiaowu X, Xianjun Y. Completely 3-dimensional laparoscopic pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: an analysis of 100 consecutive cases. Langenbecks Arch Surg 2023; 408:126. [PMID: 36971912 DOI: 10.1007/s00423-023-02763-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 11/17/2022] [Indexed: 03/29/2023]
Abstract
PURPOSE Although laparoscopic pancreaticoduodenectomy (LPD) is increasingly performed in high-volume centers, pancreaticojejunostomy (PJ) is still the most challenging procedure. Pancreatic anastomotic leakage remains a major complication after PD. Thus, various technical modifications regarding PJ, such as the Blumgart technique, have been attempted to simplify the procedure and minimize anastomotic leakage. Three-dimensional (3D) laparoscopic systems have been shown to be particularly helpful in performing difficult and precise tasks. We present a modified Blumgart anastomosis in 3D-LPD and investigate its clinical outcomes. METHODS A retrospective analysis of 100 patients who underwent 3D-LPD with modified Blumgart PJ from September 2018 to January 2020 was conducted. Data on the preoperative characteristics, operative outcomes, and postoperative characteristics of the patients were collected and analyzed. RESULTS The mean operative time and duration of PJ were 348.2 and 25.1 min, respectively. The mean estimated blood loss was 112 mL. The overall rate of postoperative complications over Clavien‒Dindo classification III was 18%. The incidence of clinically relevant postoperative pancreatic fistula was 11%. The median postoperative hospital stay was 14.2 days. Only one patient required reoperation (1%), and no patient died in the hospital or 90 days after the operation. High BMI, small main pancreatic duct diameter, and soft pancreatic consistency had a significant influence on the occurrence of CR-POPF. CONCLUSIONS The surgical outcome of 3D-LPD with modified Blumgart PJ seems to be comparable to other studies in terms of operation time, blood loss, hospital stay, and complication incidence. We consider the modified Blumgart technique in 3D-LPD to be novel, reliable, safe, and favorable for PJ in the PD procedure.
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Affiliation(s)
- Liu Wensheg
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
| | - Ji Shunrong
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Xu Wenyan
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Shi Yihua
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Liu Mengqi
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Li Zheng
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Zhuo Qifeng
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
| | - Xu Xiaowu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
| | - Yu Xianjun
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
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Restaino S, Scutiero G, Taliento C, Poli A, Bernardi G, Arcieri M, Santi E, Fanfani F, Chiantera V, Driul L, Scambia G, Greco P, Vizzielli G. Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis. Updates Surg 2023; 75:455-470. [PMID: 36811183 DOI: 10.1007/s13304-023-01465-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.
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Affiliation(s)
- S Restaino
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scutiero
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - Cristina Taliento
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy.
| | - A Poli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Bernardi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - M Arcieri
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122, Messina, Italy
| | - E Santi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - F Fanfani
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - V Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - L Driul
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - P Greco
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Laparoscopic surgery in 3D improves results and surgeon convenience in sleeve gastrectomy for morbid obesity. Langenbecks Arch Surg 2022; 407:3333-3340. [PMID: 36180641 DOI: 10.1007/s00423-022-02681-8] [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: 04/13/2022] [Accepted: 09/12/2022] [Indexed: 10/07/2022]
Abstract
PURPOSE Advanced laparoscopic procedures are still challenging. One critical issue is the lack of stereoscopic vision. The aim of this surgical study is to evaluate whether 3D vision offers any advantages for surgical performance over 2D vision during sleeve gastrectomy for morbid obesity using a laparoscopic system that allows changing between 2D and 3D optics. METHODS A total of 78 patients were analyzed, with 37 in the 2D group and 41 in the 3D group. Performance time, hospital stay, complications, and early outcomes were collected. To assess the quality of the 2D and 3D techniques, visual analog scales from 0 to 10 were designed, and image quality, depth of field, precision in performing tasks, and general ergonomics were measured. RESULTS According to the vision system used, the mean duration of surgery was 85 ± 16.8 min for patients operated on with the 2D system and 69 ± 16.9 min for those operated on with the 3D system. There were no significant differences between the overall percentages of complications according to the type of vision used. However, postoperative complications were more severe in the 2D laparoscopy group. The average length of stay was shorter for patients in the 3D group. Regarding the differences perceived by the surgeon, the depth of field and the precision of tasks were better in the 3D vision group. CONCLUSION The 3D system provided greater depth perception and precision in more complex tasks, enabling safer surgery. This led to a reduction in the operative time and hospital stay. Moreover, the severity of complications was less.
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Naceri A, Elsner J, Tröbinger M, Sadeghian H, Johannsmeier L, Voigt F, Chen X, Macari D, Jähne C, Berlet M, Fuchtmann J, Figueredo L, Feußner H, Wilhelm D, Haddadin S. Tactile Robotic Telemedicine for Safe Remote Diagnostics in Times of Corona: System Design, Feasibility and Usability Study. IEEE Robot Autom Lett 2022; 7:10296-10303. [PMID: 36345294 PMCID: PMC9454265 DOI: 10.1109/lra.2022.3191563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/21/2022] [Indexed: 08/06/2023]
Abstract
The current crisis surrounding the COVID-19 pandemic demonstrates the amount of responsibility and the workload on our healthcare system and, above all, on the medical staff around the world. In this work, we propose a promising approach to overcome this problem using robot-assisted telediagnostics, which allows medical experts to examine patients from distance. The designed telediagnostic system consists of two robotic arms. Each robot is located at the doctor and patient sites. Such a system enables the doctor to have a direct conversation via telepresence and to examine patients through robot-assisted inspection (guided tactile and audiovisual contact). The proposed bilateral teleoperation system is redundant in terms of teleoperation control algorithms and visual feedback. Specifically, we implemented two main control modes: joint-based and displacement-based teleoperation. The joint-based mode was implemented due to its high transparency and ease of mapping between Leader and Follower whereas the displacement-based is highly flexible in terms of relative pose mapping and null-space control. Tracking tests between Leader and Follower were conducted on our system using both wired and wireless connections. Moreover, our system was tested by seven medical doctors in two experiments. User studies demonstrated the system's usability and it was successfully validated by the medical experts.
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Affiliation(s)
- Abdeldjallil Naceri
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
| | - Jean Elsner
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
| | - Mario Tröbinger
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
| | - Hamid Sadeghian
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
- University of Isfahan8174673441IsfahanIran
| | - Lars Johannsmeier
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
| | - Florian Voigt
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
| | - Xiao Chen
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
| | - Daniela Macari
- Franka Emika GmbH80797MunichGermany
- Max Planck Institute for Intelligent SystemsMax Planck ETH Center for Learning Systems70569StuttgartGermany
| | | | - Maximilian Berlet
- MITI Group, University Hospital Rechts der IsarTech. University Munich80992MunichGermany
| | - Jonas Fuchtmann
- MITI Group, University Hospital Rechts der IsarTech. University Munich80992MunichGermany
| | - Luis Figueredo
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich80992MunichGermany
| | - Hubertus Feußner
- MITI Group, University Hospital Rechts der IsarTech. University Munich80992MunichGermany
| | - Dirk Wilhelm
- MITI Group, University Hospital Rechts der IsarTech. University Munich80992MunichGermany
| | - Sami Haddadin
- Munich Institute of Robotics and Machine IntelligenceTechnical University of Munich80992MunichGermany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI)80992MunichGermany
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Video Learning of Surgical Procedures: A Randomized Comparison of Microscopic, 2- and 3-Dimensional Endoscopic Ear Surgery Techniques. Otol Neurotol 2022; 43:e746-e752. [PMID: 35763494 DOI: 10.1097/mao.0000000000003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Video learning of surgical procedures helps trainees gain an initial understanding of the complex anatomy and the surgical procedure. Because no comparative studies have yet examined which microsurgical approach to the middle ear is most suitable for video learning, the authors investigated objective and subjective outcomes for medical trainees observing microscopic, 2-dimensional (2D) endoscopic, and 3- dimensional (3D) endoscopic ear surgeries. METHODS Sixty-two medical students (min. 3rd year) from the University Hospital of Bern watched three standardized videos of a type I tympanoplasty surgery recording, conducted with a microscope, a 2D endoscope, and a 3D endoscope, respectively. The authors measured participants' learning outcome, eye movements, cognitive load, and subjective preferences. RESULTS Of the 62 participants included in the study, 14 were male (22.58%), and mean age was 24.44 years (range: 21-29). Learning outcome was highest after watching the 3D endoscopic video (mean [SD], 59.48% [20.57%]). Differences in score were statistically significant: 2D endoscopic video (mean difference: -6.56%, 95% CI: -13.02 to -0.10%), microscopic video (mean difference: -13.82%, 95% CI: -20.27 to -7.36%). Participants showed lowest average eye fixation duration when watching the 3D endoscopic video (mean [SD], 307 ms [109 ms]), with statistically significant differences to the 2D endoscopic video (mean difference: -139 ms, 95% CI: -185 to -93 ms), and the microscopic video (mean difference: -264 ms, 95% CI: -310 to -218 ms). Participants reported lowest cognitive load for the 2D and 3D endoscopic videos. Ratings on discomfort, usability, naturalness, depth perception, and image quality were in favor of the 3D endoscopic video. CONCLUSION The 3D endoscopic technique offers many advantages for video learning in terms of knowledge gain, visual field exploration, and subjective evaluation. To optimize learning effects in trainees, the authors recommend the use of endoscopes in middle ear surgery and, if available, using 3D technology.
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Tan Q, Yang Y, Yao Y, Yang N, Jin L, Hu X, Xu X, Wang Z, Yang J, Zheng J. Development and Validation of a Homemade and Low-Cost Three-Dimensional Laparoscopic Simulator for Novices. J Laparoendosc Adv Surg Tech A 2022; 32:1071-1077. [PMID: 35467968 DOI: 10.1089/lap.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of this study was to design a low-cost three-dimensional (3D) laparoscopic simulator and validate its training effectiveness. Materials and Methods: We designed a low-cost 3D laparoscopic simulator using magnifying glass and cardboard box. Thirty-two laparoscopic novices were randomly divided into 3D group and two-dimensional (2D) group. The 3D group was trained on 3D simulator four times with 24 hours interval, and the 2D group was trained on 2D simulator. Five standardized laparoscopic tasks were performed by novices in each training. In the second part, subjects were transferred to the opposite simulator for one test after 24 hours of the fourth training. The completing time and errors for each task were recorded to assess the construct validity of simulator. Finally, the face validity and the content validity were evaluated through a closed-ended questionnaire. Results: There was no significant difference between the two groups in demographic or psychometric variables (P > .05). Compared with the 2D group, novices using 3D simulator had a better performance in five laparoscopic tasks, including a faster completing time (P < .001) and lower errors during training (P < .05). Additionally, the increased laparoscopic skill involved with our 3D simulator could be transferred to subsequent performance in 2D simulator (P < .05). Meanwhile, the score of face validity and content validity in our 3D simulator was significantly higher than that in 2D simulator (P < .05). Conclusion: Our 3D laparoscopic simulator effectively improved laparoscopic skills of novice surgeons, suggesting that the low-cost 3D simulator had satisfactory performance to satisfy requirement for novice training.
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Affiliation(s)
- Qi Tan
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yang Yang
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yanxi Yao
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Nengrui Yang
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Lulu Jin
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Xiangyu Hu
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Xiaolei Xu
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Zhongzheng Wang
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Jixin Yang
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Ji Zheng
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
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Wang MF, Thapa D. Assessment of 2D and 3D imaging for patients undergoing laparoscopic bariatric surgery. POLISH JOURNAL OF SURGERY 2022; 95:29-32. [PMID: 36806165 DOI: 10.5604/01.3001.0015.7972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Aim:</b> The aim of this study is to compare the association of 2D and 3D imagery with technical performance and operative time during laparoscopic surgery. </br></br> <b> Material and methods:</b> A systematic review of the literature was conducted through an online search in databases such as PubMed, Cochrane, Embase and CNKI in order to identify articles published in English and Chinese from 2010 to 2020 that compared the clinical results of 2D and 3D laparoscopic gastric bypass surgery. </br></br> <b> Results:</b> A total of 50 articles were included in the qualitative analysis. Out of these, 5 articles that met the inclusion criteria were selected for analysis, according to which 3D laparoscopic surgery had a shorter surgery time than 2D laparoscopic surgery. </br></br> <b>Conclusions:</b> Compared with a 2D laparoscopic system, a 3D laparoscopic system can significantly reduce the operative time and errors and can increase the comfort of the surgeons performing laparoscopic gastric bypass surgery.
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Affiliation(s)
- Mo Fei Wang
- Clinical Medical School of Inner Mongolia University for the Nationalities, Tongliao, Inner Mongolia, China
| | - Dil Thapa
- Clinical Medical School of Inner Mongolia University for the Nationalities, Tongliao, Inner Mongolia, China
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Milner TD, Denton O, Moen CM, Iyer A. Validation of the novel Deep Reality Viewer (DRV) 3D digital stereo viewer in otology surgery. Eur Arch Otorhinolaryngol 2022; 279:4839-4845. [PMID: 35192036 PMCID: PMC8861478 DOI: 10.1007/s00405-022-07305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/07/2022] [Indexed: 12/01/2022]
Abstract
Purpose Magnification with accurate optic reproduction of the surgical field is essential in otology surgery, but current technologies are subject to specific disadvantages. This study aims to evaluate a novel 3D digital stereo viewer, the Deep Reality Viewer (DRV), in otology surgery, in comparison to both a 2D monitor and the gold standard of microscopy. Methods In this prospective clinical research study, ENT consultants and trainees evaluated visual and practical applications of the DRV. In visual assessment, participants (n = 11) viewed pre-recorded in vivo mastoid exploration displayed on a 2D monitor and the DRV screen. In practical assessment, participants (n = 9) performed otology surgical tasks on a cadaveric human head using both the microscope and DRV. Face, task-specific (TSV) and global content (GCV) outcomes were assessed using 5-point Likert scale questionnaires. Construct validity was assessed separately. Results The DRV achieved the pre-determined validation threshold of 4 for all validation parameters in both visual and practical assessment. The DRV significantly outperformed the 2D monitor in fourteen of 16 parameters. In comparison to microscopy, there was no significant difference in 13 of 16 parameters, with the DRV significantly outperforming in the remaining 3: defining anatomy (GCV), assessing middle ear anatomy (TSV) and overall TSV. Construct validity was not demonstrated for either technology. Conclusion The DRV achieved the validation threshold for all parameters, and outperformed the 2D monitor and microscopy in several parameters. This validates the DRV for performing otological procedures, and suggests that it would be a useful alternative to the gold standard of microscopy in otology surgery. Level of evidence N/A.
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Affiliation(s)
- Thomas D Milner
- University Hospital Monklands, Otolaryngology, Airdrie, Scotland, UK.
| | - Oliver Denton
- University Hospital Monklands, Otolaryngology, Airdrie, Scotland, UK
| | - Christy M Moen
- Queen Elizabeth University Hospital, Otolaryngology, Glasgow, Scotland, UK
| | - Arunachalam Iyer
- University Hospital Monklands, Otolaryngology, Airdrie, Scotland, UK
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Three-dimensional versus two-dimensional endoscopes in anatomical orientation of the middle ear and in simulated surgical tasks. The Journal of Laryngology & Otology 2022; 136:141-145. [DOI: 10.1017/s002221512200010x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThree-dimensional endoscopes provide a stereoscopic view of the operating field, facilitating depth perception compared to two-dimensional systems, but are not yet widely accepted. Existing research addresses performance and preference, but there are no studies that quantify anatomical orientation in endoscopic ear surgery.MethodsParticipants (n = 70) were randomised in starting with either the two-dimensional or three-dimensional endoscope system to perform one of two tasks: anatomical orientation using a labelled three-dimensional printed silicone model of the middle ear, or simulated endoscopic skills. Scores and time to task completion were recorded, as well as self-reported difficulty, confidence and preference.ResultsNovice surgeons scored significantly higher in a test of anatomical orientation using three-dimensional compared to two-dimensional endoscopy (p < 0.001), with no significant difference in the speed of simulated endoscopic skills task completion. For both tasks, there was lower self-reported difficulty and increased confidence when using the three-dimensional endoscope. Participants preferred three-dimensional over two-dimensional endoscopy for both tasks.ConclusionThe findings demonstrate the superiority of three-dimensional endoscopy in anatomical orientation, specific to endoscopic ear surgery, with statistically indistinguishable performance in a skills task using a simulated trainer.
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Trute RJ, Zapico CS, Christou A, Layeghi D, Craig S, Erden MS. Development of a Robotic Surgery Training System. Front Robot AI 2022; 8:773830. [PMID: 35174216 PMCID: PMC8841469 DOI: 10.3389/frobt.2021.773830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Robotic Surgery is getting widely spread and applied to more and more clinical cases due to its advantages compared to open surgery, for both the patients and surgeons. However, Robotic Surgery requires a different set of skills and learning compared to open and also laparoscopic surgery. Tele-operation for a robotic system with hand controllers, the delay in the hand commands to be translated into robotic movements, slowness of the robotic movements, remote 2D or 3D vision of the actual operation, and lack of haptic feedback are some of the challenges that Robotic Surgery poses. Surgeons need to go through an intensive training for Robotic Surgery, and the learning and skill development continues throughout their early professional years. Despite the importance of training for Robotic Surgery, there are not yet dedicated, low-cost, and widespread training platforms; rather, surgeons mostly train with the same Robotic Surgery system they use in surgery; hence institutions need to invest on a separate surgical setup for training purposes. This is expensive for the institutions, it provides very limited access to the surgeons for training, and very limited, if any, access to researchers for experimentation. To address these, we have developed in our laboratory a low-cost, and experimental Robotic Surgery Trainer. This setup replicates the challenges that a Robotic Surgery system poses and further provides widespread access through internet connected control of the actual physical system. The overall system is composed of equipment that a standard engineering laboratory can afford. In this paper, we introduce the Robotic Surgery Training System and explain its development, parts, and functionality.
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Affiliation(s)
- Robin Julia Trute
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Centre for Robotics, University of Edinburgh, Edinburgh, United Kingdom
- *Correspondence: Robin Julia Trute,
| | - Carlos Suárez Zapico
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Centre for Robotics, University of Edinburgh, Edinburgh, United Kingdom
| | - Andreas Christou
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Centre for Robotics, University of Edinburgh, Edinburgh, United Kingdom
| | - Daniel Layeghi
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Centre for Robotics, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart Craig
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
| | - Mustafa Suphi Erden
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
- Edinburgh Centre for Robotics, University of Edinburgh, Edinburgh, United Kingdom
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Seong YW, Jeon JH, Jang HJ, Cho S, Jheon S, Kim K. Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy. J Cardiothorac Surg 2021; 16:302. [PMID: 34656152 PMCID: PMC8520266 DOI: 10.1186/s13019-021-01685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope.
Methods Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps.
Results There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II—one case of ARDS, and the other case of a delayed bronchopleural fistula. Conclusions Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.
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Affiliation(s)
- Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, Seoul, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Herlan S, Marquardt JS, Hirt B, Tatagiba M, Ebner FH. 3D Exoscope System in Neurosurgery-Comparison of a Standard Operating Microscope With a New 3D Exoscope in the Cadaver Lab. Oper Neurosurg (Hagerstown) 2020; 17:518-524. [PMID: 31140555 DOI: 10.1093/ons/opz081] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For decades, the operating microscope has been the "gold standard" visualization device in neurosurgery. The development of endoscopy revolutionized different surgical disciplines, whereas in neurosurgery, the endoscope is commonly used as an additional device more than as single visualization tool. Invention of a 3D exoscope system opens new possibilities in visualization and ergonomics in neurosurgery. OBJECTIVE To assess the prototype of a 3D exoscope (3D exoscope, year of manufacture 2015, FA Aesculap, Tüttlingen, Germany) as neurosurgical visualization device in comparison to a standard operating microscope. METHODS A pterional approach was performed in 3 ETOH-fixed specimens (6 sides). A standard operating microscope was compared to a 3D exoscope prototype. Dimensions like visual field, magnification, illumination, ergonomics, depth effect, and 3D impression were compared. RESULTS In all approaches, the structures of interest could be clearly visualized with both devices. Magnification showed similar results. The exoscope had more magnification potential, whereas the visual quality got worse in higher magnification levels. The illumination showed better results in the microscope. Surgeons felt more comfortable with the 3D exoscope, concerning ergonomic considerations. Depth effect and 3D impression showed similar results. None of the surgeons felt uncomfortable using the exoscope. CONCLUSION The operating microscope is the gold standard visualization tool in neurosurgery because of its illumination, stereoscopy, and magnification. Nevertheless, it causes ergonomic problems. The prototype of a 3D exoscope showed comparable features in visual field, stereoscopic impression, and magnification, with a clear benefit concerning the ergonomic possibilities.
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Affiliation(s)
- Stephan Herlan
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany.,Institute of Clinical Anatomy and Cell Analysis, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Jakob S Marquardt
- Department of Neurosurgery, Asklepios Klinik Nord, Heidberg, Hamburg, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Florian H Ebner
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
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Wang Z, Liang J, Chen J, Mei S, Liu Q. Three-Dimensional (3D) Laparoscopy Versus Two-Dimensional (2D) Laparoscopy: A Single-Surgeon Prospective Randomized Comparative Study. Asian Pac J Cancer Prev 2020; 21:2883-2887. [PMID: 33112544 PMCID: PMC7798154 DOI: 10.31557/apjcp.2020.21.10.2883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Visual information is crucial for performing laparoscopic surgery. While surgeons lose depth perception and spatial orientation in conventional 2D laparoscopy, the 4th generation 3D system gives a better depth perception. Objective: In this sstudy, we aimed to investigate the feasibility, safety, and short-term efficacy of 4th generation 3D-HD visualization technology applied in laparoscopic colon cancer surgery. Methods: One hundred and twenty patients with colon adenocarcinoma were recruited in this study. Patients were randomized on the day of surgery by a random computer-generated allocation list to undergo either a 3D-HD display or 2D-HD imaging system laparoscopic colon cancer surgery. In total, 60 patients underwent laparoscopic colon resection by 3D-HD laparoscope (3D group) and 60 patients underwent 2D-HD laparoscope (2D group). After the insertion of the access ports, both surgical procedures were divided in component tasks, and the execution times were compared. Data analysis was done using SPSS (version 15.0). Quantitative and qualitative variables were compared applying Student t test and Pearson’s chi-square test. Results: Two groups were homogenous in terms of demographic data. Operation time was significantly shorter for the 3D group than for the 2D group (123.2±34.2 min vs. 142.2±23.5 min, P=0.018). There was no statistically significant difference between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery, and postoperative complications (P>0.05). Conclusion: The 4th generation 3D-HD vision system reduced the operating time compared to 2D-HD vision system. It seems that use of the 3D-HD technology can significantly enhance the possibility of achieving better intraoperative results.
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Affiliation(s)
- Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianan Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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22
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Molteni G, Nocini R, Ghirelli M, Molinari G, Fior A, Veneri A, Nocini PF, Marchioni D. Free flap head and neck microsurgery with VITOM Ⓡ 3D: Surgical outcomes and surgeon's perspective. Auris Nasus Larynx 2020; 48:464-470. [PMID: 32988665 DOI: 10.1016/j.anl.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report on the application of the 3D exoscopic system to microsurgery in a cohort of head and neck cancer patients; to analyse the performance of microvascular anastomoses, flap harvesting and insetting under exoscopic view and to evaluate the surgeon's feedback after procedures. METHODS An observational study was performed on 10 consecutive patients undergoing exoscopic microsurgical free flap reconstruction. The VITOMⓇ 3D system was applied to all procedures for microsurgical anastomoses, flap harvesting and insetting. Data about the type of resection and reconstruction, intraoperative and post-operative complications were recorded. Surgeon's feedback on exoscopic experience was collected through a questionnaire. RESULTS Reconstruction after oncologic demolition was performed by radial forearm flap in 3 cases (30%), antero-lateral thigh flap in 4 cases (40%), composite fibula flap in 2 cases (20%) and chimeric scapula flap in 1 case (10%). The mean surgical time for the microsurgical anastomoses (1 vein and 1 artery) was 34 min (range: 32-38). No intraoperative complications occurred and only two patients experienced pharyngo-cutaneous fistula in the post-operative time. There were neither cases of loss of flap, nor need of surgical revision. None of the cases had to be converted to OM technique. The surgeon never experienced back/neck pain, headache and nausea/vertigo. Occasionally, he felt tired and stressed and he reported eyestrain after one procedure only. CONCLUSIONS VITOMⓇ 3D is easy to apply in the field of head and neck microsurgery and provides optimal stereoscopic view and anatomical details. Further studies are needed to validate indications and advantages of 3D exoscope as compared to OM.
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Affiliation(s)
- Gabriele Molteni
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Riccardo Nocini
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Michael Ghirelli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo, 71, 41125 Modena, Italy.
| | - Giulia Molinari
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Andrea Fior
- Division of Maxillo-facial Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Borgo Roma, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Antonio Veneri
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Pier Francesco Nocini
- Division of Maxillo-facial Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Borgo Roma, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Daniele Marchioni
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
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Mongelli F, Regina DL, Garofalo F, Vannelli A, Giuseppe MD, FitzGerald M, Marengo M. Three-dimensional laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomoses for morbid obesity. A single center experience. Acta Cir Bras 2020; 35:e202000806. [PMID: 32901683 PMCID: PMC7478489 DOI: 10.1590/s0102-865020200080000006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/10/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To assess the impact of three-dimensional (3D) vision use on operative time (OT) in laparoscopic Roux-en-Y gastric bypass (LRYGB) with hand-sewn anastomoses. METHODS We analyzed a prospectively collected database of patients who underwent LRYGB. We included all patients operated on with either 2D or 3D vision. Demographics and clinical characteristics, operative time, hospital stay and 30-day postoperative complications were collected for all patients and analyzed. RESULTS During the study time, out of 143 patients who underwent LRYGB for morbid obesity, 111 were considered eligible. Seventy-eight patients were operated with 2D vision and 33 patients with 3D vision. Demographics and clinical characteristics were not different among groups. Mean OT was 203±51 and 167±32 minutes in the 2D and 3D groups respectively (p<0.001). Multivariate analyses showed that increasing age and BMI were independently related to prolonged OT, while 3D vision (OR 6.675, 95% CI 2.380-24.752, p<0.001) was strongly associated with shorter OT. CONCLUSIONS The use of 3D vision in LRYGB significantly reduced the OT, though intra- and postoperative complication rates and the length of hospital stay were not affected. Despite its limitations, our study supports the value of 3D vision laparoscopy in bariatric surgery.
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24
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Surgical implications of 3D vs 2D endoscopic ear surgery: a case–control study. Eur Arch Otorhinolaryngol 2020; 277:3323-3330. [DOI: 10.1007/s00405-020-06040-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022]
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25
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Bracale U, Merola G, Rizzuto A, Pontecorvi E, Silvestri V, Pignata G, Pirozzi F, Cuccurullo D, Sciuto A, Corcione F. Does a 3D laparoscopic approach improve surgical outcome of mininvasive right colectomy? A retrospective case-control study. Updates Surg 2020; 72:445-451. [PMID: 32232743 DOI: 10.1007/s13304-020-00755-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
Laparoscopy has gained wide acceptance due its benefits for patients. However, advanced laparoscopic procedures are still challenging. One critical issue is lack of stereoscopic vision. Despite its diffusion, the totally laparoscopic approach for right hemicolectomy (TLRC) is still debated due to its difficulty, particularly for fashioning of the ileocolic anastomosis. The aim of this multicenter study is to investigate whether 3D vision offers any advantages on surgical performance over 2D vision during TLRC. All data of consecutive patients who underwent elective TLRC for cancer at three Italian surgical centers with either 2D or 3D technology from January 2013 to December 2018 were retrieved from a computer-maintained database. A case-matched analysis using the Mantel-Haenszel method was performed. After matching, a total of 106 patients were analyzed with 53 patients in each group. Mean operative time was significantly longer for 2D-TLRC than for 3D-TLRC (153.2 ± 52.4 vs. 131 ± 51 min, p = 0.029) and a statistically significant difference in anastomosing time (p = 0.032, 19.2 ± 5.9 min vs. 21.7 ± 6.2 min for 3D and 2D group, respectively) was also recorded. No difference in the median number of harvested nodes (23 ± 11 vs. 21 ± 7 for 3D and 2D group, respectively; p = 0.48) was found. Neither intraoperative complications nor conversions occurred in the two groups. In conclusion, 3D vision appears to improve the performance of a TLRC by reducing operative time and making intracorporeal anastomosis easier. Prospective randomized studies are required to determine the real beneficial effects.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy.
| | - Giovanni Merola
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Antonia Rizzuto
- Medical and Surgical Science, University "Magna Graecia" of Catanzaro Medical School, Catanzaro, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Vania Silvestri
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili of Brescia, Brescia, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Diego Cuccurullo
- Department of General Surgery, Ospedali dei Colli Monaldi Hospital, Naples, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
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Alhusuny A, Cook M, Khalil A, Xie Y, Johnston V. Neck/Shoulder Problems and Visual Disturbances Among Surgeons: A Scoping Review. J Surg Res 2020; 247:413-428. [PMID: 31679800 DOI: 10.1016/j.jss.2019.09.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Minimally invasive surgeries are the surgical techniques that lower the size of incisions needed but may increase the physical problems such as neck/shoulder problems and visual disturbances among surgeons. This study aims to determine the prevalence, severity, proposed risk factors, and evidence for a relationship for neck/shoulder problems and visual disturbances (separately and concurrently) among surgeons. MATERIALS AND METHODS A scoping review using the five-stage framework proposed by Arksey and O'Malley was conducted. This included identification of a research question and relevant studies, study selection, charting of data and collating, summarizing, and reporting of the results. Databases searched were PubMed, Embase, CINAHL, Cochrane Library and Web of Science, and Scopus, alongside a hand-search. An Appraisal tool for Cross-Sectional Studies was used to determine methodological quality of studies. RESULTS Ten articles met the inclusion criteria from 744 identified. Prevalence were reported by all the studies and ranged from 6% to 74% (neck); 7%-35% (right shoulder); 8%-39% (left shoulder); 9%-80% (both shoulders), and 0.4%-63% (visual disturbances). Severity of these concerns was assessed in four studies and was variable. The risk factors for neck/shoulder problems and visual disturbances included workplace physical ergonomic factors, surgery factors, and surgeon-related factors. None of the included studies proposed a relationship between neck/shoulder problems and visual disturbances. CONCLUSIONS There was great variability in the reported prevalence of neck/shoulder problems and visual disturbances among surgeons. Neck/shoulder problems and visual disturbances shared several risk factors, but the link between the two issues has not been fully investigated.
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Affiliation(s)
- Ameer Alhusuny
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, 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
| | - Yanfei Xie
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
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Abstract
Robotic surgery has rapidly evolved. It is particularly attractive as an alternative minimally invasive approach in liver surgery because of improvements in visualization and articulated instruments. Limitations include increased operative times and lack of tactile feedback, but these have not been shown in studies. Considerations unique to robotic surgery, including safety protocols, must be put in place and be reviewed at the beginning of every procedure to ensure safety in the event of an emergent conversion. Despite the lack of early adoption by many hepatobiliary surgeons, robotic liver surgery continues to evolve and find its place within hepatobiliary surgery.
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Affiliation(s)
- Kelly J Lafaro
- Department of Surgery, Johns Hopkins University School of Medicine, Blalock Building, 600 N. Wolfe St, Baltimore, MD 21205, USA
| | - Camille Stewart
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Abigail Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA; Department of Surgery, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Stewart CL, Wong P, Selby L, Warner SG, Raoof M, Singh G, Fong Y, Melstrom LG. Minimally invasive distal pancreatectomy and the cost of conversion. J Surg Oncol 2020; 121:670-675. [PMID: 31967336 DOI: 10.1002/jso.25852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 12/26/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is preferred for distal pancreatectomy but is not always attempted due to the risk of conversion to open. We hypothesized that the total cost for MIS converted to open procedures would be comparable to those that started open. METHODS A prospectively collected institutional registry (2011-2017) was reviewed for demographic, clinical, and perioperative cost data for patients undergoing distal pancreatectomy. RESULTS There were 80 patients who underwent distal pancreatectomy: 41 open, 39 MIS (11 laparoscopic and 28 robotic). Conversion to open occurred in 14 of 39 (36%, 3 laparoscopic and 11 robotic). Length of stay was shorter for the MIS completed (6 days; range, 3-8), and MIS converted to open (7 days; range, 4-10) groups, compared with open (10 days; range, 5-36; P = .003). Laparoscopic cases were the least expensive (P = .02). Robotic converted to open procedures had the highest operating room cost. However, the total cost for robotic converted to open cohort was similar to the open cohort due to cost savings associated with a shorter length of stay. CONCLUSIONS Despite the higher intraoperative costs of robotic surgery, there is no significant overall financial penalty for conversion to open. Financial considerations should not play a role in selecting a robotic or open approach.
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Affiliation(s)
| | - Paul Wong
- Department of Surgery, City of Hope, Duarte, California
| | - Luke Selby
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Mustafa Raoof
- Department of Surgery, City of Hope, Duarte, California
| | | | - Yuman Fong
- Department of Surgery, City of Hope, Duarte, California
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Gabrielli ME, Saun TJ, Jung JJ, Grantcharov TP. Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery. JAMA Netw Open 2020; 3:e1920084. [PMID: 31995217 PMCID: PMC6991293 DOI: 10.1001/jamanetworkopen.2019.20084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Errors and adverse events occur frequently in health care. Three-dimensional (3-D) laparoscopic systems claim to provide more realistic depth perception and better spatial orientation compared with their 2-D counterparts. OBJECTIVE To compare the association of 3-D vs 2-D systems with technical performance during laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures using a multiport intraoperative data capture system. DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed between May and December 2018, with a total of 50 LRYGB procedures performed in an academic tertiary care center; recordings of the operations were evaluated with a 30-day follow-up. All procedures were performed by the same surgical team. EXPOSURE Surgical teams used 2-D or 3-D laparoscopic systems. MAIN OUTCOMES AND MEASURES Technical performance was evaluated using the Objective Structured Assessment of Technical Skill and surgical errors and events using the Generic Error Rating Tool. RESULTS Of the 50 patients who underwent LRYGB procedures, 42 (86%) were women, with a median (interquartile range) age of 42 (35-47) years and a median (interquartile range) body mass index of 46 (42-48), with no significant demographic differences between the groups whose operations were performed using the 2-D and 3-D systems. The mean (SD) number of errors per case was significantly lower in procedures using the 3-D laparoscopic system than in those using the 2-D system (17 [6] vs 33 [2]; P < .001). The mean (SD) number of error-related events was significantly lower in procedures using the 3-D system than in those using the 2-D system (6 [2] vs 11 [4]; P < .001). Mean (SD) Objective Structured Assessment of Technical Skill scores were significantly higher when the 3-D system was used than when the 2-D system was used (28 [4] vs 22 [3]; P < .001). CONCLUSIONS AND RELEVANCE In this limited sample of LRYGB procedures, the use of a 3-D laparoscopic system was associated with a statistically significant reduction in errors and events as well as higher Objective Structured Assessment of Technical Skill scores compared with 2-D systems.
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Affiliation(s)
- Mauricio E. Gabrielli
- International Centre for Surgical Safety, St Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Centre for Biomedical Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tomas J. Saun
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James J. Jung
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Dirie NI, Wang Q, Wang S. Two-Dimensional Versus Three-Dimensional Laparoscopic Systems in Urology: A Systematic Review and Meta-Analysis. J Endourol 2019; 32:781-790. [PMID: 29969912 PMCID: PMC6156697 DOI: 10.1089/end.2018.0411] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the three-dimensional (3D) laparoscopic system in comparison with two-dimensional (2D) laparoscopy for treatment of different urological conditions. METHODS Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in Web of Science, PubMed, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2018. Articles published in the English language of both randomized and observational studies comparing 3D and 2D laparoscopic systems in urological surgeries were included. Level of evidence and quality assessments of all included studies were conducted. Interested data were extracted for comparison and meta-analysis. RESULTS Our literature search generated 17 studies comparing 3D and 2D laparoscopic systems in different urological surgeries. Of these, 13 studies containing 548 and 449 patients operated on with 2D and 3D laparoscopic systems, respectively, were included for meta-analysis. These 13 studies were divided into three groups according to surgical type. Group 1: Partial nephrectomy (PN); operative time (p = 0.19), estimated blood loss (EBL) (p = 0.51), dissecting time (p = 0.58), and suturing time (p = 0.28) were not statistically significant between 2D and 3D laparoscopic systems. However, warm ischemia time during PN was significantly shorter during 3D laparoscopy (p < 0.00001). Group 2: Pyeloplasty; this procedure showed no significant difference between the two systems. Group 3: Radical prostatectomy (RP); shorter operative time (p < 0.0001) and lower EBL (p = 0.001) were associated with the 3D laparoscopic system. CONCLUSION Three-dimensional laparoscopy mainly improves the depth of perception, leading to better visibility, which is important for some complex urological surgeries such as PN, pyeloplasty, and RP. Based on our findings, 3D laparoscopy seems to provide better clinical and surgical outcomes in some urological procedures compared with conventional 2D laparoscopy.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
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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: 1.8] [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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Schwab KE, Curtis NJ, Whyte MB, Smith RV, Rockall TA, Ballard K, Jourdan IC. 3D laparoscopy does not reduce operative duration or errors in day-case laparoscopic cholecystectomy: a randomised controlled trial. Surg Endosc 2019; 34:1745-1753. [PMID: 31312963 PMCID: PMC7093411 DOI: 10.1007/s00464-019-06961-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/01/2019] [Indexed: 12/20/2022]
Abstract
Background Contemporary 3D platforms have overcome past deficiencies. Available trainee and laboratory
studies suggest stereoscopic imaging improves performance but there is little clinical data or studies assessing specialists. We aimed to determine whether stereoscopic (3D) laparoscopic systems reduce operative time and number of intraoperative errors during specialist-performed laparoscopic cholecystectomy (LC). Methods A parallel arm (1:1) randomised controlled trial comparing 2D and 3D passive-polarised laparoscopic systems in day-case LC using was performed. Eleven consultant surgeons that had each performed > 200 LC (including > 10 3D LC) participated. Cases were video recorded and a four-point difficulty grade applied. The primary outcome was overall operative time. Subtask time and the number of intraoperative consequential errors as identified by two blinded assessors using a hierarchical task analysis and the observational clinical human reliability analysis technique formed secondary endpoints. Results 112 patients were randomised. There was no difference in operative time between 2D and 3D LC (23:14 min (± 10:52) vs. 20:17 (± 9:10), absolute difference − 14.6%, p = 0.148) although 3D surgery was significantly quicker in difficulty grade 3 and 4 cases (30:23 min (± 9:24), vs. 18:02 (± 7:56), p < 0.001). No differences in overall error count was seen (total 47, median 1, range 0–4 vs. 45, 1, 0–3, p = 0.62) although there were significantly fewer 3D gallbladder perforations (15 vs. 6, p = 0.034). Conclusion 3D laparoscopy did not reduce overall operative time or error frequency in laparoscopic cholecystectomies performed by specialist surgeons. 3D reduced Calot’s dissection time and operative time in complex cases as well as the incidence of iatrogenic gallbladder perforation (NCT01930344). Electronic supplementary material The online version of this article (10.1007/s00464-019-06961-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katie E Schwab
- Minimal Access Therapy Training Unit, University of Surrey, Daphne Jackson Road, Guildford, UK. .,Department of General Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, UK. .,Department of Surgery, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Castle Lane East, Bournemouth, UK.
| | - Nathan J Curtis
- Department of Surgery and Cancer, Imperial College London, Praed Street, London, UK.,Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | | | - Ralph V Smith
- Minimal Access Therapy Training Unit, University of Surrey, Daphne Jackson Road, Guildford, UK.,Department of Surgery, Frimley Park Hospital, Portsmouth Rd, Frimley, UK
| | - Timothy A Rockall
- Minimal Access Therapy Training Unit, University of Surrey, Daphne Jackson Road, Guildford, UK.,Department of General Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | | | - Iain C Jourdan
- Department of General Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, UK
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Wehr F, Held J. Stereoscopic versus monoscopic displays: Learning fine manual dexterity skills using a microsurgical task simulator. APPLIED ERGONOMICS 2019; 77:40-49. [PMID: 30832777 DOI: 10.1016/j.apergo.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/18/2018] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
We investigated the learning of fine manual dexterity with a microsurgical instrument and a new simulator in a context of microsurgery. 30 subjects were divided into two groups. One (3D group) interacted with a stereoscopic and the other (2D group) with a monoscopic display. Visual information for the displays was captured from a surgical stereomicroscope. In 20 trials, both groups performed the repetitive tasks of picking up small rods from a funnel-shaped cavity and placing them outside. In analysing learning curves, we found that the initial learning process for hand-eye coordination is easier with a 3D display, and that performance persists at a higher level of proficiency than with the 2D display option. Thus stereoscopic displays can be especially beneficial for novices, for those learning new procedures, or for providing orientation to operators facing a new or altered spatial situation. Simulators with few reliefs or spatial textures should not be used for comparison between 3D and 2D viewing conditions.
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Affiliation(s)
- Franka Wehr
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
| | - Jürgen Held
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
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34
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Koinuma K, Horie H, Ito H, Naoi D, Sadatomo A, Tahara M, Inoue Y, Kono Y, Sasaki T, Sugimoto H, Lefor AK, Sata N. Four-directional approach to the meso-transverse attachment combined with preoperative radiological vascular simulation facilitates short-term surgical outcomes in laparoscopic transverse colon cancer surgery. Asian J Endosc Surg 2019; 12:150-156. [PMID: 29963764 DOI: 10.1111/ases.12628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/24/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Transverse colon resection is one of the most difficult laparoscopic procedures because of anatomic hazards such as variations in the mesenteric vascular anatomy and the complex structure of organs and surrounding membranes. METHODS We evaluated the short-term surgical outcomes of laparoscopic transverse colon resection using a creative approach. This approach included preoperative surgical simulation using virtual surgical anatomy by CT, a four-directional approach to the mesentery, and 3-D imaging during laparoscopic surgery. RESULTS A total of 45 consecutive patients who underwent laparoscopic resection for transverse colon cancer from June 2013 to December 2017 were enrolled in this study. All procedures were completed safely, with minor postoperative complications, including two patients with anastomotic stenosis, two with intra-abdominal phlegmon, one with delayed gastric emptying, and one with pneumonia, all treated non-operatively. There were no conversions to open resection. Operation time was 203 min (range, 125-322 min), and the estimated blood loss during surgery was 5 mL (range, 0-370 mL). The mean postoperative hospital stay was 10 days (range, 7-21 days), and no patients required readmission. CONCLUSION Short-term surgical outcomes after laparoscopic transverse colon resection demonstrated that this creative approach was safe and feasible. The four-directional approach to the meso-transverse attachment combined with preoperative radiological simulation can facilitate laparoscopic transverse colon surgery.
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Affiliation(s)
- Koji Koinuma
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Homare Ito
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Daishi Naoi
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Ai Sadatomo
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Makiko Tahara
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yoshiyuki Inoue
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yoshihiko Kono
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Takahiro Sasaki
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | - Hideharu Sugimoto
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | | | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
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Zang X, Huang HL, Xie B, Liu J, Guo HM. A comparative study of three-dimensional high-definition and two-dimensional high-definition video systems in totally endoscopic mitral valve replacement. J Thorac Dis 2019; 11:788-794. [PMID: 31019766 DOI: 10.21037/jtd.2019.02.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Three-dimensional vision with improved depth perception and spatial orientation has already proved its superiority to the two-dimensional vision in endoscopic surgery. However, those benefits remain unidentified in cardiac surgery. For the first time, we compare performance of a three-dimensional high-definition video system with a two-dimensional high-definition video system in patients undergoing totally endoscopic mitral valve replacement. Methods We enrolled 90 patients with mitral valve disease in a single institution, from June 2013 to June 2016. Totally endoscopic mitral valve replacement was performed by the same surgeon using either a three-dimensional high-definition (n=43) or a two-dimensional high-definition (n=47) video system with the same surgical technique. Short-term outcomes were compared between the two groups. All medical records were retrieved from a prospectively maintained database of minimally invasive cardiac surgery. Results All surgeries were successfully completed under totally endoscopic guidance. There were no intraoperative complications in either group. The use of three-dimensional video system reduced aortic cross-clamp time by approximately 10% (3D vs. 2D: 65.74±14.32 vs. 72.67±14.67 min, P=0.027). No significant differences were observed in cardiopulmonary bypass time, postoperative ventilation duration, length of surgical intensive care unit stay, length of hospital stay, and major complications between the two groups. There were no perioperative deaths in either group. Conclusions Compared with the two-dimensional video system, the three-dimensional high-definition video system provided a better surgical experience with the same operative safety for totally endoscopic mitral valve replacement.
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Affiliation(s)
- Xin Zang
- Department of Adult Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Huan-Lei Huang
- Department of Adult Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Bin Xie
- Department of Adult Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jian Liu
- Department of Adult Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hui-Ming Guo
- Department of Adult Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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36
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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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Liang H, Liang W, Lei Z, Liu Z, Wang W, He J, Zeng Y, Huang W, Wang M, Chen Y, He J. Three-Dimensional Versus Two-Dimensional Video-Assisted Endoscopic Surgery: A Meta-analysis of Clinical Data. World J Surg 2018; 42:3658-3668. [PMID: 29946785 DOI: 10.1007/s00268-018-4681-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND There have been no studies to systematically evaluate the two display (3D vs. 2D) systems regarding both laparoscopic and thoracoscopic surgeries in clinical settings; thus, we conducted one to evaluate the safety and efficacy of different visualization systems (two-dimensional and three-dimensional) during endoscopic surgery (laparoscopy or thoracoscopy) in clinical settings. METHODS A comprehensive search of online databases was performed. Perioperative outcomes were synthesized. Cumulative meta-analysis was performed to evaluate the temporal trend of pooled outcomes. Specific subgroups (laparoscopy vs. thoracoscopy, prospective vs. retrospective study, malignant vs. benign diseases) were examined. Meta-regression was conducted to explore the source of heterogeneity. RESULTS Twenty-three articles were considered in this analysis, of which 7 were thoracoscopic and 16 were laparoscopic surgeries. A total of 2930 patients were recorded, of which 1367 underwent 3D video-assisted surgery and 1563 underwent 2D display. Overall, significantly shorter operating time (SMD -0.69; p = <0.001), less blood loss (SMD -0.26; p = 0.028) and shorter hospital stays (SMD -0.16; p = 0.016) were found in the 3D display group. Meanwhile, the perioperative morbidity (OR 0.92; p = 0.487), retrieved lymph nodes (SMD 0.09; p = 0.081), drainage duration (SMD -0.15; p = 0.105) and drainage volume (SMD 0.00; p = 0.994) were similar between the two groups. Comparison of the overall outcomes in each subset showed consistency in all groups. CONCLUSIONS This up-to-date meta-analysis reveals that the 3D display system is superior to the 2D system in clinical settings with significantly shorter operating time, less blood loss and shorter hospital stay. These findings suggest that, in laparoscopic or thoracoscopic surgeries, 3D endoscopic system is preferable when condition permits. Future efforts should be made on decreasing the side effects of 3D display and increasing its cost-effectiveness.
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Affiliation(s)
- Hengrui Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Wenhua Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Zhao Lei
- The Sixth Affiliated Hospital, School of Basic Medical Sciences, Functional Experiment Center, Guangzhou Medical University, Guangzhou, 511436, China
| | - Zhichao Liu
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Wei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jiaxi He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yuan Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Weizhe Huang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Manting Wang
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yuehan Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China.
- National Clinical Research Center for Respiratory Center for Respiratory Disease, Guangzhou, 510120, China.
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Robotic surgery trends in general surgical oncology from the National Inpatient Sample. Surg Endosc 2018; 33:2591-2601. [PMID: 30357525 DOI: 10.1007/s00464-018-6554-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robotic surgery is offered at most major medical institutions. The extent of its use within general surgical oncology, however, is poorly understood. We hypothesized that robotic surgery adoption in surgical oncology is increasing annually, that is occurring in all surgical sites, and all regions of the US. STUDY DESIGN We identified patients with site-specific malignancies treated with surgical resection from the National Inpatient Sample 2010-2014 databases. Operations were considered robotic if any ICD-9-CM robotic procedure code was used. RESULTS We identified 147,259 patients representing the following sites: esophageal (3%), stomach (5%), small bowel (5%), pancreas (7%), liver (5%), and colorectal (75%). Most operations were open (71%), followed by laparoscopic (26%), and robotic (3%). In 2010, only 1.1% of operations were robotic; over the 5-year study period, there was a 5.0-fold increase in robotic surgery, compared to 1.1-fold increase in laparoscopy and 1.2-fold decrease in open surgery (< 0.001). These trends were observed for all surgical sites and in all regions of the US, they were strongest for esophageal and colorectal operations, and in the Northeast. Adjusting for age and comorbidities, odds of having a robotic operation increased annually (5.6 times more likely by 2014), with similar length of stay (6.9 ± 6.5 vs 7.0 ± 6.5, p = 0.52) and rate of complications (OR 0.91, 95% CI 0.83-1.01, p = 0.08) compared to laparoscopy. CONCLUSIONS Robotic surgery as a platform for minimally invasive surgery is increasing over time for oncologic operations. The growing use of robotic surgery will affect surgical oncology practice in the future, warranting further study of its impact on cost, outcomes, and surgical training.
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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: 12] [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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Yoon J, Kang SI, Kim MH, Kim MJ, Oh HK, Kim DW, Kang SB. Comparison of Short-Term Outcomes Between 3D and 2D Imaging Laparoscopic Colectomy with D3 Lymphadenectomy for Colon Cancer. J Laparoendosc Adv Surg Tech A 2018; 29:340-345. [PMID: 30222527 DOI: 10.1089/lap.2018.0317] [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] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) imaging for laparoscopy was introduced to overcome the limitations of conventional two-dimensional (2D) imaging that lacked depth perception and spatial orientation. This study aimed to evaluate the effect of 3D imaging in laparoscopic colectomy with D3 lymphadenectomy for colon cancer. METHODS From February 2014 to October 2016, the prospective database of 278 consecutive patients with colon cancer was analyzed retrospectively; these patients underwent laparoscopic surgery with 2D (n = 111) and 3D (n = 167) imaging, with curative intent. RESULTS No difference was found in sex, body mass index, history of abdominal surgery, and American Society of Anesthesiologists grade between the 3D and 2D groups. The estimated blood loss was less in the 3D group than in the 2D group (50 mL [30-100 mL] versus 100 mL [50-100 mL], P < .001). The number of resected lymph nodes was higher in the 3D group (n = 47 [37.5-60] versus 41 [32-51.5], P = .001). However, a difference in operative time was not observed in both groups (150 minutes [125-175 minutes] versus 155 minutes [135-177.5 minutes], P = .186). Postoperative morbidity was similar in both groups (7.8% versus 8.1%, P = 1.000). Time to pass first flatus (3 days [2-4 days] versus 3 days [3-4 days], P = .746) and postoperative hospital stay (6 days [6-8 days] versus 6 days [6-7 days], P = .087) were also similar. CONCLUSIONS This study shows that laparoscopic colectomy with D3 lymphadenectomy for colon cancer using 3D laparoscopic systems appears to be beneficial, with less blood loss, which should be addressed in prospective studies.
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Affiliation(s)
- Jin Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Il Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Hyun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myung Jo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
BACKGROUND The 3D laparoscopy is currently under intensive discussion. At the moment the majority of newly acquired laparoscopy systems include the 3D technique. New 4K systems, which will be offered in combination with 3D, are complicating the decision-making when buying new laparoscopic systems. The aim of the article is to show the advantages and possible limitations of 3D laparoscopy. Furthermore, the position of 3D laparoscopy in the current video market is evaluated. MATERIAL AND METHODS This study was based on an up to date literature search in PubMed. Concerning the question whether the 3D is replacing the 2D laparoscopy, observations from the industry and a personal evaluation were included in the analysis. RESULTS The current studies show clear advantages of 3D laparoscopy concerning operation time, efficiency and workload. A major proportion of the studies were conducted on simulation trainers; however, some clinical trials also confirmed these results. The learning curve in laparoscopic surgery is clearly improved with the 3D technique and 3D also seems be useful for operations by experts. The limitation is that not every surgeon can see three dimensionally. Furthermore, the set-up in the operation room needs to be optimized so that a 3D system can be successfully implemented with the nursing staff and side effects, such as exhaustion, dizziness or headache can be prevented. CONCLUSION The choice of video system will depend on the personal interest of the surgeon and the ability to see 3D. It can be assumed that the majority of the systems will include 3D laparoscopy but 2D laparoscopy will not be completely replaced. A dynamic development of 3D in association with 4K and robotics can be expected.
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Affiliation(s)
- A Buia
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Asklepios Kliniken Langen, Röntgenstr. 20, 63225, Langen, Deutschland
| | - S Farkas
- Klinik für Allgemein- und Viszeralchirurgie, St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189, Wiesbaden, Deutschland.
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Quiles C, Constantino JA, Gañán Y, Macías D, Quiles M. Stereophotogrammetric surface anatomy of the anterior cruciate ligament's tibial footprint: Precise osseous structure and distances to arthroscopically-relevant landmarks. Knee 2018; 25:531-544. [PMID: 29705076 DOI: 10.1016/j.knee.2018.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/16/2018] [Accepted: 03/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND While femoral tunnel malposition is widely recognized as the main technical error of failed anterior cruciate ligament (ACL) surgery, tibial tunnel malposition is likely underrecognized and underappreciated. PURPOSE To describe more precisely the qualitative and quantitative anatomy of the ACL's tibial attachment in vitro using widely available technology for stereophotogrammetric surface reconstruction, and to test its applicability in vivo. METHODS Stereophotogrammetric surface reconstruction was obtained from fourteen proximal tibias of cadaver donors. Measurements of areas and distances from the center of the ACL footprint and the footprint of the obtained bundles to selected arthroscopically-relevant anatomic landmarks were carried out using a three-dimensional design software program, and means and 95% confidence intervals were calculated for these measurements. Reference landmarks were tested in three-dimensional models obtained with arthroscopic videos. MAIN FINDINGS The osseous footprint of the ACL was described in detail, including its precise elevated limits, size, and shape, with its elevation pattern described as a quarter-turn-staircase-like ridge. Its internal indentations were related to inter-spaces identified as bundle divisions. Distances from the footprint center to arthroscopically relevant landmarks were obtained and compared to its internal structure, yielding a useful X-like landmark pointing to the most accurate placeholder for the ACL footprint's "anatomic" center. Certain structures and reference landmarks described were readily recognized in three-dimensional models from arthroscopic videos. CONCLUSIONS Stereophotogrammetric surface reconstruction is an accessible technique for the investigation of anatomic structures in vitro, offering a detailed three-dimensional depiction of the ACL's osseous footprint.
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Affiliation(s)
- Carlos Quiles
- Department of Orthopaedic Surgery and Traumatology, University Hospital Infanta Cristina, Badajoz 06080, Spain.
| | - Juan A Constantino
- Department of Orthopaedic Surgery and Traumatology, University Hospital Infanta Cristina, Badajoz 06080, Spain; Department of Medico-Surgical Therapy, University of Extremadura, Badajoz 06080, Spain.
| | - Yolanda Gañán
- Department of Anatomy, Cell Biology, and Zoology, University of Extremadura, Badajoz 06080, Spain.
| | - Domingo Macías
- Department of Anatomy, Cell Biology, and Zoology, University of Extremadura, Badajoz 06080, Spain.
| | - Manuel Quiles
- Department of Orthopaedic Surgery and Traumatology, University Hospital Infanta Cristina, Badajoz 06080, Spain; Department of Medico-Surgical Therapy, University of Extremadura, Badajoz 06080, Spain.
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Lin CC, Huang SC, Lin HH, Huang WJ, Chen WS, Yang SH. Naked-eye box trainer and training box games have similar training effect as conventional video-based box trainer for novices: A randomized controlled trial. Am J Surg 2018; 216:1022-1027. [PMID: 29859628 DOI: 10.1016/j.amjsurg.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 04/26/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Laparoscopic surgery has become a well-established technique for management of various surgical problems. A more efficient training methods are of upmost importance for current surgery residents. METHODS This is a prospective, randomized, 3-arm trial to compare the training efficient of the naked-eye box trainer, training box games and conventional video-based box trainer in training laparoscopic suturing skill. RESULTS The three training models were well acceptable and all could improve the acquisition of laparoscopic suturing and knotting skill in novices. The completion time was 604 ± 298 s in the box trainer games, 617 ± 335 s in the naked-eye training module, and 491 ± 334 s in the video-based box trainer (p = 0.322). Using the structured procedure-specific checklist, there was no significant difference in scores between these three groups (p = 0.977). CONCLUSIONS Naked-eye box trainer and training box games produce similar training effect as the conventional video-based box trainer. The naked-eye box trainer may serve as a convenient way for novice trainees to acquire laparoscopic suturing technique skills before video-based simulation.
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Affiliation(s)
- Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Chieh Huang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Urology and Physiology, School of Medicine, Shu-Tien Urological Research Center, National Yang-Ming University, Taiwan
| | - Wei-Shone Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Randomized study of the influence of two-dimensional versus three-dimensional imaging using a novel 3D head-mounted display (HMS-3000MT) on performance of laparoscopic inguinal hernia repair. Surg Endosc 2018; 32:4624-4631. [PMID: 29777354 DOI: 10.1007/s00464-018-6215-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND 3D laparoscopy has proven to be superior to the 2D approach in experimental settings. The aim of the present study was to investigate the influence of 3D laparoscopy using a novel head-mounted display on the performance of defined steps within a laparoscopic inguinal hernia repair. This effect was investigated both in laparoscopically advanced surgeons and in beginners. METHODS Patients suffering from symptomatic inguinal hernia were randomly assigned to laparoscopic hernia repair using either a head-mounted 3D display or a conventional 2D laparoscopic approach. Operative performance of both groups was compared in terms of the time taken for mesh placement and for peritoneal suturing. Additionally, quality of imaging and physical discomfort were assessed. RESULTS The use of a head-mounted 3D display was able to shorten the time required for placement of the mesh as well as that for peritoneal suturing, both for experienced and novice surgeons when compared to the conventional 2D approach. 3D laparoscopy was significantly superior to 2D laparoscopy in terms of depth perception, image sharpness and image contrast. Additionally, increased impairment caused by ghosting effects could not be detected in 3D laparoscopy. Evaluation of image quality was independent of experience in laparoscopic surgery. However, use of a head-mounted 3D display resulted in a significant impairment of surgeon's comfort when compared to 2D laparoscopy. Thereby, the greatest impairment was caused by ear discomfort. CONCLUSIONS This is the first study examining the effect of a head-mounted 3D system on the performance of laparoscopy in a randomized controlled trial (RCT) showing a clear advantage of this system in surgical performance as well as in depth perception and image quality.
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Xu J, Liao K, Luo Y. Clinical Study of Three Dimensional Endoscopic Technique in the Treatment of Thyroid Neoplasm. J Laparoendosc Adv Surg Tech A 2018; 28:1003-1007. [PMID: 29698122 DOI: 10.1089/lap.2017.0689] [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] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of three-dimensional (3D) endoscopic technique in clinical practice. METHODS A retrospective analysis of the clinical data of 180 cases of endoscopic thyroid surgery, 88 cases by umbrella 3D endoscopic technique (observation group), 92 cases with common endoscopic technique (control group), comparing two groups of patients with age, surgery related indicators, postoperative complications, recovery condition and others. RESULTS There was no significant difference in the average age, tumor diameter, intraoperative bleeding, postoperative drainage, hospitalization time, and pain scores after surgery between the to groups (P > .05); the operation time of the observation group was shorter than the control group [(93.8 + 33.7) minutes versus (135.5 + 37.5) minutes, P < .05]. There was no hoarseness in the observation group, and 2 cases in the control group had transient hoarseness and no permanent hoarseness. CONCLUSION The surgical application of 3D endoscopic technique can shorten the time of endoscopic thyroid surgery, reduce the risk of recurrent laryngeal nerve injury, reduce the operation difficulty and operation pressure, greatly reduce the risk of surgical patients, and increase the safety of surgery.
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Affiliation(s)
- Jiasheng Xu
- 1 Graduate School of Nanchang University , Nanchang, China .,2 Department of General Surgery, First Affiliated Hospital of Nanchang University , Nanchang, China
| | - Kaili Liao
- 1 Graduate School of Nanchang University , Nanchang, China
| | - Yuting Luo
- 2 Department of General Surgery, First Affiliated Hospital of Nanchang University , Nanchang, China
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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: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [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
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48
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Zihni A, Gerull WD, Cavallo JA, Ge T, Ray S, Chiu J, Brunt LM, Awad MM. Comparison of precision and speed in laparoscopic and robot-assisted surgical task performance. J Surg Res 2018; 223:29-33. [DOI: 10.1016/j.jss.2017.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 11/27/2022]
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Wilhelm D, Vogel T, Ostler D, Marahrens N, Kohn N, Koller S, Friess H, Kranzfelder M. Enhanced Visualization: From Intraoperative Tissue Differentiation to Augmented Reality. Visc Med 2018; 34:52-59. [PMID: 29594170 DOI: 10.1159/000485940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Optimal visualization of the operative field and methods that additionally provide supportive optical information form the basis for target-directed and successful surgery. This article strives to give an overview of current enhanced visualization techniques in visceral surgery and to highlight future developments. Methods The article was written as a comprehensive review on this topic and is based on a MEDLINE search and ongoing research from our own group and from other working groups. Results Various techniques for enhanced visualization are described comprising augmented reality, unspecific and targeted staining methods, and optical modalities such as narrow-band imaging. All facilitate our surgical performance; however, due to missing randomized controlled studies for most of the innovations reported on, the available evidence is low. Conclusion Many new visualization technologies are emerging with the aim to improve our perception of the surgical field leading to less invasive, target-oriented, and elegant treatment forms that are of significant benefit to our patients.
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Affiliation(s)
- Dirk Wilhelm
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Vogel
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Ostler
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nils Marahrens
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nils Kohn
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Koller
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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50
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Vettoretto N, Foglia E, Ferrario L, Arezzo A, Cirocchi R, Cocorullo G, Currò G, Marchi D, Portale G, Gerardi C, Nocco U, Tringali M, Anania G, Piccoli M, Silecchia G, Morino M, Valeri A, Lettieri E. Why laparoscopists may opt for three-dimensional view: a summary of the full HTA report on 3D versus 2D laparoscopy by S.I.C.E. (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie). Surg Endosc 2018; 32:2986-2993. [PMID: 29368286 PMCID: PMC5956063 DOI: 10.1007/s00464-017-6006-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
Background Three-dimensional view in laparoscopic general, gynaecologic and urologic surgery is an efficient, safe and sustainable innovation. The present paper is an extract taken from a full health technology assessment report on three-dimensional vision technology compared with standard two-dimensional laparoscopic systems. Methods A health technology assessment approach was implemented in order to investigate all the economic, social, ethical and organisational implications related to the adoption of the innovative three-dimensional view. With the support of a multi-disciplinary team, composed of eight experts working in Italian hospitals and Universities, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaire and self-reported interviews, applying a final MCDA quantitative approach, and considering the dimensions resulting from the EUnetHTA Core Model. Results From systematic search of literature, we retrieved the following studies: 9 on general surgery, 35 on gynaecology and urology, both concerning clinical setting. Considering simulated setting we included: 8 studies regarding pitfalls and drawbacks, 44 on teaching, 12 on surgeons’ confidence and comfort and 34 on surgeons’ performances. Three-dimensional laparoscopy was shown to have advantages for both the patients and the surgeons, and is confirmed to be a safe, efficacious and sustainable vision technology. Conclusions The objective of the present paper, under the patronage of Italian Society of Endoscopic Surgery, was achieved in that there has now been produced a scientific report, based on a HTA approach, that may be placed in the hands of surgeons and used to support the decision-making process of the health providers. Electronic supplementary material The online version of this article (10.1007/s00464-017-6006-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nereo Vettoretto
- Montichiari Surgery, ASST degli Spedali Civili di Brescia, V.le Ciotti 154, 25018, Montichiari (BS), Italy.
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, LIUC-Università Carlo Cattaneo, Castellanza (VA), Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, LIUC-Università Carlo Cattaneo, Castellanza (VA), Italy
| | - Alberto Arezzo
- Center for Minimal Invasive Surgery, University of Turin School of Medicine, Turin, Italy
| | - Roberto Cirocchi
- General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Gianfranco Cocorullo
- General and Emergency Surgery, Azienda Ospedaliera Universitaria Policlinico P. Giaccone, Palermo, Italy
| | - Giuseppe Currò
- General and Oncologic Surgery, University of Messina, Messina, Italy
| | - Domenico Marchi
- General Surgery, Ospedale Civile di Baggiovara, Modena, Italy
| | | | - Chiara Gerardi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Umberto Nocco
- Clinical Engineering, ASST Settelaghi, Varese, Italy
| | | | - Gabriele Anania
- General and Thoracic Surgery, University of Ferrara, Ferrara, Italy
| | - Micaela Piccoli
- General Surgery, Ospedale Civile di Baggiovara, Modena, Italy
| | | | - Mario Morino
- Center for Minimal Invasive Surgery, University of Turin School of Medicine, Turin, Italy
| | - Andrea Valeri
- General, Emergency and Minimally Invasive Surgery, Azienda Ospedaliera Universitaria Careggi Firenze, Firenze, Italy
| | - Emauele Lettieri
- Deparment of Management, Economics and Industrial Engineering, Milan Politecnico, Milan, Italy.,Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
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