3D Laparoscopy: A Potential Cutting Edge in Minimal Invasive Digestive Surgery

Abstract

Laparoscopic surgery has changed surgical landscape, providing reduced surgical trauma, shorter hospital stays, less postoperative pain and better outcomes than open surgery. Since its first development in the 90’s, 3D technology applied to laparoscopic surgery has had several technical improvements and now it represents, together with high definition technology, the best option in minimal invasive digestive surgery, providing shorter operative times and lower blood loss, making easier to perform surgical tasks both for trainees than for skilled surgeons. It remains a little bit more expensive than standard 2D laparoscopic devices but even cheaper than robotic equipment. Gastro Med Res Copyright © Simone Sibio 2/3 How to cite this article: Simone S, Sara di C, Giuseppe S S. 3D Laparoscopy: A Potential Cutting Edge in Minimal Invasive Digestive Surgery. Gastro Med Res. 2(3). GMR.000539. 2018. DOI: 10.31031/GMR.2018.02.000539 Volume 2 Issue 3 laparoscopy with regards to performance time. The results for the experimental trials showed predominantly an improvement in time and a reduction in number of errors with 3D laparoscopy. The experimental setting does not reflect the complexity of clinical conditions and this could explain why neither operative time nor decrease in errors were reported in other clinical trials [20]. However, results from our initial experience with 3d laparoscopy on 95 patients (55 colorectal resections, 32 cholecystectomies, 5 gastrectomies, 3 distal pancreatectomies) showed that use of 3d device in most common digestive surgical procedures carry shorter operative time and lower blood loss, although complications, hospital stay and conversion rates, as well as hospital expenses do not change by using 3d rather than 2d laparoscopy [21]. These results are confirmed by those of a recent large metanalysis including 21 studies (13 retrospective and 8 randomized trials) which analyzed existing experiences on several similar digestive surgical procedures (cholecystectomy, appendectomy, gastric resections, colorectal resections, hepatectomy, oesophagectomy) [16,20,22,23]. As reported in available papers in literature, 3D vision seems to offer technical advantages in deep surgical fields, for vessel identification and ligation and in the accuracy of surgical manipulation as a result of the increased depth perception [18,20,24]. Currently, conclusive evidences that analyze the comparative efficacy of tridimensional laparoscopy remain in scarcity. Sorensen et al. [23] performed a systematic review of 3D laparoscopy vs 2D laparoscopy on simulated settings. Their results merely revealed a better performance on surgical tasks and trainings by tridimensional laparoscopy. By far, larger scale randomized trials on this topic are still lacking and no consensus has been reached among current literature. The main results, regarding comfort for the surgeon, have been investigated in simulated settings that have shown a better depth perception, hand-eyes coordination and accuracy. The performances, in particular for novice surgeons, appear to be improved using 3D vision, with faster and more precise resolution of laparoscopic tasks [7,25-27] Sensation of neck and back pain, physical fatigue, nausea and dizziness have different rates between the clinical setting (in which they appear to be worse for 3D vision) and the simulated setting (in which they ameliorate for 3D vision), even if the worse results seem to be associated with earlier 3D systems [18]. Crosstalk and ghosting as a result of a non-optimal use of 3D visualization influences the laparoscopic performance and workload as shown by Sakata [28,29]. All these suggested that there is a need for further studies and investigation.