3D versus 2D laparoscopy: comparative assessment using a validated Program for Laparoscopic Urologic Skills
Antonio Cicionea,d, Riccardo Autorinob, Alberto Bredac, Marco De Siob,
Rocco Damianod, Ferdinando Fuscoe, Francesco Grecof, Emanuel Carvalho-Diasa
Pedro Pinhoa, Vincenzo Mironee, Estevao Limaa
aLife and Health Sciences Research Institute, Universidade do Minho, Braga, Portugal; bUrology Unit, Second University, Naples, Italy; cDepartment of Urology, Universidad Autonoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain; d Urology Unit, Magna Graecia University, Catanzaro, Italy; eDepartment of Urology, Federico II University, Napoli, Italy; f Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany
INTRODUCTION AND PURPOSE: Three dimensional imaging (3D) has been recently introduced in the field of laparoscopic surgery with the potential of optimizing the surgical performance. Aim of this study was to compare 3D versus standard 2D laparoscopy in the laboratory setting using a validated program for laparoscopic urological skills.
MATHERIAL AND METHOD: Digital 3D and 2D STORZ systems were used during the 4th Minimal Invasive Urological Surgical Week Course held in University of Minho, Braga, Portugal. The course participants agreed to participate and included in the study. Each participant was asked to complete a baseline questionnaire, and then to perform the five tasks (ie peg transfer; cutting a circle; single knot tying; clip and cut; needle guidance) of the European Training in Basic Laparoscopic Urological Skills (E-BLUS) with both the 3D and the 2D system. A computer-generated randomization sequence was used to allocate the participant in two study groups, the first starting with 3D, the other with 2D. Time to perform each five exercise, number of errors, and laparoscopic experience level were recorded. Finally, a end-of-study questionnaire was filled.
RESULTS: A total of 10 faculty and fellows with extensive or some degree of experience with laparoscopy and 23 laparoscopy-naïve residents were included in the study. Overall, no significant difference between 2D and 3D laparoscopy was found in terms of time need to complete the task and number of error. However, when considering only laparoscopic-naïve participants, a statistically significant advantage was found using the 3D in three out of five exercises. Interestingly, participants indicated exercise number 5 (needle guidance) as the one with a subjective perception of benefit provided by the 3D vision. Only 11/23 of the residents (47%) considered 3D easier than 2D laparoscopy.
DISCUSSION: 3D vision improves depth perception and spatial orientation during laparoscopy, potentially facilitating laparoscopic procedures. In our experience, 3D seemed to allow less experienced surgeons to be more precise, especially in terms of ambidexterity or precision of cutting. In surgeons with previous laparoscopic experience, the better view obtained with 3D vision seems not to translate in an immediate advantage when performing in the dry lab. Small sample size can be regarded as a limitation of the present study.
CONCLUSIONS: 3D imaging seems to facilitate surgical performance of urologic surgeons without laparoscopic background in the dry lab setting. The advantage of 3D for those with some degree of laparoscopic experience remains to be demonstrated. Moreover, further studies are needed to determine the actual advantage of 3D laparoscopy over standard 2D laparoscopy in the clinical setting.