Kozlov Yury, Kovalkov Konstantin, Nowogilov Vladimir
1 Department of Neonatal Surgery, Municipal Pediatric Hospital , Irkutsk, Russia .
2 Department of Pediatric Surgery, Irkutsk State Medical Academy of Continuing Education (IGMAPO) , Irkutsk, Russia .
J Laparoendosc Adv Surg Tech A. 2016 Dec;26(12):1021-1027. doi: 10.1089/lap.2016.0155. Epub 2016 Sep 22.
This study focuses on the successful application of three-dimensional (3D) laparoscopic surgeries in the treatment of congenital anomalies and acquired diseases in the young pediatric population. The purpose of this scientific work consists in highlighting the spectrum, indications, applicability, and effectiveness of 3D endosurgery in children.
Our experience is based on 110 endosurgical procedures performed in neonates and infants in the 3D format between January 2014 and May 2015. Depending on the type of operations, all patients were divided into the following groups: (1) inguinal herniorrhaphy (IH)-63 patients; (2) Nissen fundoplication (NF)-22 patients; (3) pyeloureteral anastomosis (PUA)-15 patients; (4) nephrectomy (NE)-5 patients; and (5) ovarian cystectomy (OC)-5 patients. The patients of the first three groups were compared with babies who underwent standard laparoscopic surgery, performed in the two-dimensional (2D) format during the same time period. The groups were organized according to patient demographics, operative report, and postoperative parameters.
The patients were similar in terms of demographics and other preoperative parameters. There were significant differences in mean operative time between 3D and 2D procedures in the groups of patients with hydronephrosis and gastroesophageal reflux, which used manipulation with internal sutures (NF-37.95 minutes versus 48.42 minutes, P = .014; PUA-61.31 minutes versus 78.75 minutes, P = .019), but not in group after IH (15.88 minutes versus 15.57 minutes, P = .681). Postoperative parameters such as length of hospital stay and the number of complications were equivalent between groups.
In this study, we demonstrated the success of 3D laparoscopy in small babies with inguinal hernia, gastroesophageal reflux, hydronephrosis, ovarian cyst, and multicystic kidney. Laparoscopy in 3D format lessens the duration of complex procedures, which utilize the use of the suture technique into the abdominal cavity. The perception of depth and the presence of tactile feedback make 3D laparoscopic surgery more acceptable when compared to traditional laparoscopy.
本研究聚焦于三维（3D）腹腔镜手术在小儿先天性畸形和后天性疾病治疗中的成功应用。这项科研工作的目的在于突出3D内镜手术在儿童中的应用范围、适应证、适用性及有效性。
我们的经验基于2014年1月至2015年5月间以3D形式为新生儿和婴儿实施的110例内镜手术。根据手术类型，所有患者被分为以下几组：（1）腹股沟疝修补术（IH）——63例患者；（2）尼森胃底折叠术（NF）——22例患者；（3）肾盂输尿管吻合术（PUA）——15例患者；（4）肾切除术（NE）——5例患者；（5）卵巢囊肿切除术（OC）——5例患者。将前三组患者与同期接受二维（2D）标准腹腔镜手术的婴儿进行比较。根据患者人口统计学特征、手术报告及术后参数进行分组。
患者在人口统计学特征及其他术前参数方面相似。在肾盂积水和胃食管反流患者组中，3D手术与2D手术的平均手术时间存在显著差异，这两组手术需在腹腔内进行缝合操作（NF组：37.95分钟对48.42分钟，P = 0.014；PUA组：61.31分钟对78.75分钟，P = 0.019），但在腹股沟疝修补术后的组中无差异（15.88分钟对15.57分钟，P = 0.681）。术后参数如住院时间和并发症数量在各组间相当。
在本研究中，我们证明了3D腹腔镜手术在患有腹股沟疝、胃食管反流、肾盂积水、卵巢囊肿及多囊肾的小婴儿中的成功应用。3D腹腔镜手术缩短了利用腹腔内缝合技术的复杂手术的时长。与传统腹腔镜手术相比，深度感知和触觉反馈的存在使3D腹腔镜手术更易被接受。
