Elsevier

Urology

Volume 82, Issue 6, December 2013, Pages 1444-1450
Urology

Technology and Engineering
Three-dimensional vs Standard Laparoscopy: Comparative Assessment Using a Validated Program for Laparoscopic Urologic Skills

https://doi.org/10.1016/j.urology.2013.07.047Get rights and content

Objective

To compare the last generation of 3-dimensional imaging (3D) vs standard 2-dimensional imaging (2D) laparoscopy.

Materials and Methods

A prospective observational study was conducted during the 4th Minimally Invasive Urological Surgical Week Course held in Braga (Portugal) in April 2013. The course participants and faculty were asked to perform standardized tasks in the dry laboratory setting and randomly assigned into 2 study groups; one starting with 3D, the other with 2D laparoscopy. The 5 tasks of the European Training in Basic Laparoscopic Urological Skills were performed. Time to complete each task and errors made were recorded and analyzed. An end-of-study questionnaire was filled by the participants.

Results

Ten laparoscopic experts and 23 laparoscopy-naïve residents were included. Overall, a significantly better performance was obtained using 3D in terms of time (1115 seconds, interquartile range [IQR] 596-1469 vs 1299 seconds, IQR 620-1723; P = .027) and number of errors (2, IQR 1-3 vs 3, IQR 2-5.5; P = .001). However, the experts were faster only in the “peg transfer” task when using the 3D, whereas naïves improved their performance in 3 of the 5 tasks. A linear correlation between level of experience and performance was found. Three-dimensional imaging was perceived as “easier” by a third of the laparoscopy-naïve participants (P = .027).

Conclusion

Three-dimensional imaging seems to facilitate surgical performance of urologic surgeons without laparoscopic background in the dry laboratory setting. The advantage provided by 3D for those with previous laparoscopic experience remains to be demonstrated. Further studies are needed to determine the actual advantage of 3D over standard 2D laparoscopy in the clinical setting.

Section snippets

Participants and Setting

The present study was carried out at the Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, during the 4th Minimally Invasive Urological Surgical Week annual course in Braga, Portugal in April 2013. Faculty members and course participants agreed to participate and were included in the study. Each participant was asked to complete standardized tasks in the dry laboratory, using both 2D and 3D systems. A computer-generated randomization sequence was used

Results

Overall, 33 urologic surgeons participated in the study, including 10 “experts” (median age 45 years; interquartile range [IQR] 38-54) and 23 “laparoscopy-naïve” residents (median age 27 years; IQR 25-28; P = 0.001). Most of the participants worked in a teaching hospital (29 of 33; 87.8%).

Table 1 summarizes the overall time used to complete the task and number of errors using 2D or 3D system. The use of 3D was associated with a faster (median 1115 [IQR: 596-1469] vs 1299 [IQR: 620-1723]

Comment

Despite its increasing adoption in urology over the last 2 decades, it is well established that laparoscopy carries intrinsic limitations, including reduced depth perception of the operative field caused by the use of 2D monitors, poor hand-eye coordination as a result of location of the monitor, variable amplification, and mirrored movement, and reduced haptic feedback from the use of long surgical instruments.

To partially overcome these challenges, recent technological advances allowed the

Conclusion

The latest generation of 3D imaging for laparoscopy seems to facilitate surgical performance of urologic surgeons without laparoscopic background. For those with established laparoscopic background, the advantage provided by the use of 3D remains to be determined. Further studies with larger sample size are needed to determine the actual effect of using 3D laparoscopy in the clinical setting.

Acknowledgments

The authors thank the 4th Minimally Invasive Urological Surgical Week course attendees who participated in this study. They also thank The Research Endoscopic Laboratory at the University of Minho and the support of Karl Storz, Germany for providing instrumentation used in the study.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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