Sørensen Stine Maya Dreier, Savran Mona Meral, Konge Lars, Bjerrum Flemming
Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark.
Department of Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Surg Endosc. 2016 Jan;30(1):11-23. doi: 10.1007/s00464-015-4189-7. Epub 2015 Apr 4.
Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy.
A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction.
Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71%) showed a reduction in performance time, and 12 out of 19 (63%) showed a significant reduction in error when using 3D compared to 2D.
Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.
腹腔镜手术应用广泛，与开腹手术相比，其能加快患者康复时间并缩短住院时长。然而，与开放手术相比，腹腔镜手术更具挑战性，部分原因在于外科医生必须通过监视器上的二维（2D）投影在三维（3D）空间中操作，这会导致深度感知丧失。为解决这一问题，开发了用于腹腔镜检查的3D成像技术。进行了一项文献系统综述以评估3D腹腔镜检查的效果。
对文献进行系统检索，以确定比较3D与2D腹腔镜检查的随机对照试验。检索按照PRISMA指南，使用PubMed、EMBASE和Cochrane图书馆电子数据库完成。不设语言或出版年份限制。提取的数据包括队列规模和特征、所培训的技能或进行的手术、使用的器械、结局指标和结论。两名独立作者进行检索和数据提取。
筛选了340篇文章以确定其是否符合纳入标准，31项随机对照试验被纳入综述。3项试验在临床环境中进行，28项试验使用模拟环境。所有试验均将时间用作结局指标，31项试验中有19项将错误数量用作结局指标。31项试验中有22项（71%）显示使用3D时操作时间减少，19项试验中有12项（63%）显示与2D相比，使用3D时错误显著减少。
总体而言，与2D腹腔镜检查相比，3D腹腔镜检查似乎能提高速度并减少操作错误数量。迄今为止，大多数研究在模拟环境中评估3D腹腔镜检查，3D腹腔镜检查对临床结局的影响尚未得到研究。
