Feng Xiaoyan, Morandi Anna, Boehne Martin, Imvised Tawan, Ure Benno M, Kuebler Joachim F, Lacher Martin
Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Surg Endosc. 2015 May;29(5):1231-9. doi: 10.1007/s00464-015-4083-3. Epub 2015 Feb 12.
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.
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.
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.
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.
三维（3D）成像技术是腹腔镜手术领域一项最新的技术创新，据推测它能增强深度感知并便于手术操作。然而，在焦点靠近光学系统的情况下，它从未得到过评估。因此，尚不清楚3D摄像头能否提高新生儿和婴儿的腹腔镜手术表现。我们在模拟新生儿患者大小的兔子身上进行腹腔镜手术时，对3D视觉与二维（2D）视觉进行了测试。
使用新西兰白兔尸体（平均体重2755克），由两位有二维腹腔镜手术经验的外科医生和两位外科住院医师（具备二维腹腔镜手术基本技能）进行手术操作。所有外科医生均从未进行过三维腹腔镜手术。动物接受六项手术：nissen胃底折叠术、小肠吻合术以及使用二维或三维技术闭合膈疝缺损。主要终点指标是累积手术时间以及每项手术的手术时间。次要终点指标包括外科医生的血流动力学反应和心理应激水平。最后，通过问卷调查评估关于深度感知的主观数据。
专家使用三维腹腔镜时，所有三种手术的累积手术时间显著缩短（三维：23.01±5.65分钟 vs 二维：29.51±7.51分钟，p<0.01），住院医师使用三维腹腔镜时同样如此（三维：27.95±3.69分钟 vs 二维：33.95±6.21分钟，p<0.05）。这种效果在专家组的每项手术以及住院医师组的nissen胃底折叠术中均有体现。二维和三维成像在血流动力学反应以及心理应激水平方面没有差异。三维提供了更好的深度感知。
在狭小空间中进行三维腹腔镜手术可显著缩短手术时间。对于不熟悉三维成像的外科医生而言，它不会引起额外的身体或心理应激。因此，三维技术可能有助于新生儿和婴儿的微创手术。
