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3-Dimensional (3D) laparoscopy improves operating time in small spaces without impact on hemodynamics and psychomental stress parameters of the surgeon

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An Erratum to this article was published on 18 March 2015

Abstract

Background and purpose

Three-dimensional (3D) imaging, a recent technical innovation in laparoscopic surgery, has been postulated to enhance depth perception and facilitate operations. However, it has never been evaluated in conditions where the focus is close to the optical system. Thus, it is unclear whether 3D cameras can improve laparoscopic surgical performance in neonates and infants. We tested 3D versus two-dimensional (2D) vision during laparoscopic surgery in rabbits, mimicking the size of a neonatal patient.

Materials and methods

Cadaver New Zealand white rabbits (mean weight 2,755 g) were operated by two surgeons experienced in 2D laparoscopic surgery and two surgical residents (with basic skills in 2D laparoscopy). All surgeons had never performed 3D laparoscopic surgery. Animals underwent six operations: Nissen fundoplication, small bowel anastomosis, and closure of a diaphragmatic defect using either 2D or 3D. Primary endpoint was cumulative operating time and operating time of each operation. Secondary endpoints included the hemodynamic response and psychomental stress level of the surgeons. Finally, subjective data on depth perception were assessed by questionnaires.

Results

Cumulative operating time of all three types of operations was significantly shorter with 3D laparoscopy in experts (3D: 23.01 ± 5.65 min vs 2D: 29.51 ± 7.51 min, p < 0.01) and residents (3D: 27.95 ± 3.69 min vs 2D: 33.95 ± 6.21 min, p < 0.05). This effect could be shown for each operation in the expert group and the Nissen fundoplication in the resident group. There were no differences in the hemodynamic response as well as the psychomental stress level between 2D and 3D imaging. 3D provided better depth perception.

Conclusion

3D laparoscopy in small spaces is associated with a significant shorter operating time. It induces no additional physical or psychomental stress in surgeons naive to 3D imaging. 3D may therefore facilitate minimal invasive surgery in neonates and infants.

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References

  1. Kuebler JF, Ure BM (2011) Minimally invasive surgery in the neonate. Semin Fetal Neonatal Med 16:151–156

    Article  PubMed  Google Scholar 

  2. Lacher M, Kuebler JF, Dingemann J, Ure BM (2014) Minimal invasive surgery in the newborn: current status and evidence. Semin Pediatr Surg 23:249–256

    Article  Google Scholar 

  3. Dingemann C, Petersen C, Kuebler JF, Ure BM, Lacher M (2013) Laparoscopic transperitoneal heminephrectomy for duplex kidney in infants and children: a comparative study. J Laparoendosc Adv Surg Tech A 23:889–893

    Article  PubMed  Google Scholar 

  4. Lacher M, Kuebler JF, Yannam GR, Aprahamian CJ, Perger L, Beierle EA, Anderson SA, Chen MK, Harmon CM, Muensterer OJ (2013) Single-incision pediatric endosurgery for ovarian pathology. J Laparoendosc Adv Surg Tech A 23:291–296

    Article  PubMed  Google Scholar 

  5. Dingemann J, Ure BM (2013) Systematic review of level 1 evidence for laparoscopic pediatric surgery: do our procedures comply with the requirements of evidence-based medicine? Eur J Pediatr Surg 23:474–479

    Article  PubMed  Google Scholar 

  6. Impellizzeri P, Simona A, Grasso M, Antonuccio P, Crisafi C, Scalfari G, Arena F, Salpietro C, Lima M, Romeo C (2014) Surgical stress after open and transumbilical laparoscopic-assisted appendectomy in children. Eur J Pediatr Surg 24:174–178

    PubMed  Google Scholar 

  7. Sun CC, Chiu AW, Chen KK, Chang LS (2000) Assessment of a three-dimensional operating system with skill tests in a pelvic trainer. Urol Int 64:154–158

    Article  CAS  PubMed  Google Scholar 

  8. Chan AC, Chung SC, Yim AP, Lau JY, Ng EK, Li AK (1997) Comparison of two-dimensional vs three-dimensional camera systems in laparoscopic surgery. Surg Endosc 11:438–440

    Article  CAS  PubMed  Google Scholar 

  9. Hanna GB, Cuschieri A (1999) Influence of optical axis-to-target view angle on endoscopic task performance. Surg Endosc 13:371–375

    Article  CAS  PubMed  Google Scholar 

  10. Cicione A, Autorino R, Breda A, De Sio M, Damiano R, Fusco F, Greco F, Carvalho-Dias E, Mota P, Nogueira C, Pinho P, Mirone V, Correia-Pinto J, Rassweiler J, Lima E (2013) Three-dimensional vs standard laparoscopy: comparative assessment using a validated program for laparoscopic urologic skills. Urology 82:1444–1450

    Article  PubMed  Google Scholar 

  11. Votanopoulos K, Brunicardi FC, Thornby J, Bellows CF (2008) Impact of three-dimensional vision in laparoscopic training. World J Surg 32:110–118

    Article  PubMed  Google Scholar 

  12. Storz P, Buess GF, Kunert W, Kirschniak A (2012) 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc 26:1454–1460

    Article  PubMed  Google Scholar 

  13. Tanagho YS, Andriole GL, Paradis AG, Madison KM, Sandhu GS, Varela JE, Benway BM (2012) 2D versus 3D visualization: impact on laparoscopic proficiency using the fundamentals of laparoscopic surgery skill set. J Laparoendosc Adv Surg Tech A 22:865–870

    Article  PubMed  Google Scholar 

  14. Bilgen K, Uestuen M, Karakahya M (2013) Comparison of 3D imaging and 2D imaging for performance time of laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 23:180–183

    Article  PubMed  Google Scholar 

  15. Tuschy B, Berlit S, Brade J, Sütterlin M, Hornemann A (2014) Full High-definition three-dimensional gynaecological laparoscopy–clinical assessment of a new robot-assisted device. In Vivo 28:111–115

    PubMed  Google Scholar 

  16. Norozi K, Beck C, Osthaus WA, Wille I, Wessel A, Bertram H (2008) Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth 100:88–94

    Article  CAS  PubMed  Google Scholar 

  17. Engelmann C, Schneider M, Kirschbaum C, Grote G, Dingemann J, Schoof S, Ure BM (2011) Effects of intraoperative breaks on mental and somatic operator fatigue: a randomized clinical trial. Surg Endosc 25:1245–1250

    Article  PubMed  Google Scholar 

  18. http://faculty.washington.edu/chudler/java/redgreen.html

  19. http://www.freepacman.org/

  20. Feng C, Rozenblit JW, Hamilton AJ (2010) A computerized assessment to compare the impact of standard, stereoscopic, and high-definition laparoscopic monitor displays on surgical technique. Surg Endosc 24:2743–2748

    Article  PubMed  Google Scholar 

  21. Badani KK, Bhandari A, Tewari A, Menon M (2005) Comparison of two-dimensional and three-dimensional suturing: is there a difference in a robotic surgery setting? J Endourol 19:1212–1215

    Article  PubMed  Google Scholar 

  22. ElSahwi KS, Hooper C, De Leon MC, Gallo TN, Ratner E, Silasi DA, Santin AD, Schwartz PE, Rutherford TJ, Azodi M (2012) Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynecol Oncol 124:260–264

    Article  PubMed  Google Scholar 

  23. Simforoosh N, Khazaeli M, Nouralizadeh A, Soltani MH, Samzadeh M, Saffarian O, Rahmani J (2011) Laparoscopic animal surgery for training without sacrificing animals; introducing the rabbit as a model for infantile laparoscopy. J Laparoendosc Adv Surg Tech A 21:929–933

    Article  PubMed  Google Scholar 

  24. Molinas CR, Binda MM, Mailova K, Koninckx PR (2004) The rabbit nephrectomy model for training in laparoscopic surgery. Hum Reprod 19:185–190

    Article  PubMed  Google Scholar 

  25. Aykan S, Singhal P, Nguyen DP, Yigit A, Tuken M, Yakut E, Colakerol A, Sulejman S, Semercioz A (2014) Perioperative, pathologic, and early continence outcomes comparing three-dimensional and two-dimensional display systems for laparoscopic radical prostatectomy–a retrospective, single-surgeon study. J Endourol 28:539–543

    Article  PubMed  Google Scholar 

  26. Berguer R, Smith WD, Chung YH (2001) Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc 15:1204–1207

    Article  CAS  PubMed  Google Scholar 

  27. Klein MI, Warm JS, Riley MA, Matthews G, Doarn C, Donovan JF, Gaitonde K (2012) Mental workload and stress perceived by novice operators in the laparoscopic and robotic minimally invasive surgical interfaces. J Endourol 26:1089–1094

    Article  PubMed  Google Scholar 

  28. van der Schatte Olivier RH, van‘t Hullenaar CDP, Ruurda JP, Broeders IAMJ (2009) Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 23:1365–1371

    Article  PubMed Central  PubMed  Google Scholar 

  29. Silvestri M, Simi M, Cavallotti C, Vatteroni M, Ferrari V, Freschi C, Valdastri P, Menciassi A, Dario P (2011) Autostereoscopic three-dimensional viewer evaluation through comparison with conventional interfaces in laparoscopic surgery. Surg Innov 18:223–230

    Article  PubMed  Google Scholar 

  30. Ohuchida K, Kenmotsu H, Yamamoto A, Sawada K, Hayami T, Morooka K, Hoshino H, Uemura M, Konishi K, Yoshida D, Maeda T, Ieiri S, Tanoue K, Tanaka M, Hashizume M (2009) The effect of CyberDome, a novel 3-dimensional dome-shaped display system, on laparoscopic procedures. Int J Comput Assist Radiol Surg 4:125–132

    Article  PubMed  Google Scholar 

  31. Kong SH, Oh BM, Yoon H, Ahn HS, Lee HJ, Chung SG, Shiraishi N, Kitano S, Yang HK (2010) Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera. Surg Endosc 24:1132–1143

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Karl Storz for providing the 3D and related laparoscopic equipment. We further thank Osypka, Berlin, Germany, for providing the Aesculon® monitor.

Disclosures

Drs. Xiaoyan Feng, Anna Morandi, Martin Boehne, Tawan Imvised, Benno M. Ure, Joachim F. Kuebler and Martin Lacher have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Xiaoyan Feng, Anna Morandi, Tawan Imvised, Benno M. Ure, Joachim F. Kuebler & Martin Lacher

  2. Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany

    Martin Boehne

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  1. Xiaoyan Feng
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  2. Anna Morandi
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  7. Martin Lacher
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Correspondence to Martin Lacher.

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Feng, X., Morandi, A., Boehne, M. et al. 3-Dimensional (3D) laparoscopy improves operating time in small spaces without impact on hemodynamics and psychomental stress parameters of the surgeon. Surg Endosc 29, 1231–1239 (2015). https://doi.org/10.1007/s00464-015-4083-3

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