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High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems

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Abstract

Background

Three-dimensional (3D) imaging systems have been introduced worldwide for surgical instrumentation. A difficulty of laparoscopic surgery involves converting two-dimensional (2D) images into 3D images and depth perception rearrangement. 3D imaging may remove the need for depth perception rearrangement and therefore have clinical benefits.

Methods

We conducted a multicenter, open-label, randomized trial to compare the surgical outcome of 3D-high-definition (HD) resolution and 2D-HD imaging in laparoscopic radical prostatectomy (LRP), in order to determine whether an LRP under HD resolution 3D imaging is superior to that under HD resolution 2D imaging in perioperative outcome, feasibility, and fatigue. One-hundred twenty-two patients were randomly assigned to a 2D or 3D group. The primary outcome was time to perform vesicourethral anastomosis (VUA), which is technically demanding and may include a number of technical difficulties considered in laparoscopic surgeries.

Results

VUA time was not significantly shorter in the 3D group (26.7 min, mean) compared with the 2D group (30.1 min, mean) (p = 0.11, Student’s t test). However, experienced surgeons and 3D-HD imaging were independent predictors for shorter VUA times (p = 0.000, p = 0.014, multivariate logistic regression analysis). Total pneumoperitoneum time was not different. No conversion case from 3D to 2D or LRP to open RP was observed. Fatigue was evaluated by a simulation sickness questionnaire and critical flicker frequency. Results were not different between the two groups. Subjective feasibility and satisfaction scores were significantly higher in the 3D group.

Conclusions

Using a 3D imaging system in LRP may have only limited advantages in decreasing operation times over 2D imaging systems. However, the 3D system increased surgical feasibility and decreased surgeons’ effort levels without inducing significant fatigue.

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Acknowledgments

Dr. Toshiro Terachi, Tokai University, provided valuable support. All Imaging systems used in this study, including a 3D Laparo-Thoraco Videoscope (LTF-Y0009), Video Processor (OTV-Y0018), a Xenon Light Source (CLV-Y0013), a 3D Mixer (MAJ-Y0041) (Olympus Medical Systems Corp. Tokyo, Japan), and a 24-inch Polarized LCD (LMD-2451MT) (Sony Corp. Tokyo, Japan), were borrowed from Olympus Medical Systems Corp.

Disclosures

Drs. Hidefumi Kinoshita, Ken Nakagawa, Yukio Usui, Masatsugu Iwamura, Akihiro Ito, Yoichi Arai, Shiro Baba, and Tadashi Matsuda have received honoraria and research funding from Olympus Medical Systems Corp. Drs. Akira Miyajima and Akio Hoshi have received research funding from Olympus Medical Systems Corp.

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Authors and Affiliations

  1. Department Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan

    Hidefumi Kinoshita & Tadashi Matsuda

  2. Department of Urology, Keio University School of Medicine, Tokyo, Japan

    Ken Nakagawa & Akira Miyajima

  3. Department of Urology, Tokai University Hospital, Isehara, Japan

    Yukio Usui & Akio Hoshi

  4. Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan

    Masatsugu Iwamura & Shiro Baba

  5. Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Akihiro Ito & Yoichi Arai

Authors
  1. Hidefumi Kinoshita
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  2. Ken Nakagawa
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  7. Akio Hoshi
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  9. Shiro Baba
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  10. Tadashi Matsuda
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Corresponding author

Correspondence to Tadashi Matsuda.

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Kinoshita, H., Nakagawa, K., Usui, Y. et al. High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems. Surg Endosc 29, 2203–2209 (2015). https://doi.org/10.1007/s00464-014-3925-8

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  • DOI: https://doi.org/10.1007/s00464-014-3925-8

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