Vilaça Jaime, Pinto José Pedro, Fernandes Sandra, Costa Patrício, Pinto Jorge Correia, Leão Pedro
1 Hospital da Arrábida, Luz Saúde, Portugal.
3 University of Minho, Braga, Portugal.
Surg Innov. 2017 Dec;24(6):598-604. doi: 10.1177/1553350617728160. Epub 2017 Sep 5.
Usually laparoscopy is performed by means of a 2-dimensional (2D) image system and multiport approach. To overcome the lack of depth perception, new 3-dimensional (3D) systems are arising with the added advantage of providing stereoscopic vision. To further reduce surgery-related trauma, there are new minimally invasive surgical techniques being developed, such as LESS (laparoendoscopic single-site) surgery. The aim of this study was to compare 2D and 3D laparoscopic systems in LESS surgical procedures.
All participants were selected from different levels of experience in laparoscopic surgery-10 novices, 7 intermediates, and 10 experts were included. None of the participants had had previous experience in LESS surgery. Participants were chosen randomly to begin their experience with either the 2D or 3D laparoscopic system. The exercise consisted of performing an ex vivo pork cholecystectomy through a SILS port with the assistance of a fixed distance laparoscope. Errors, time, and participants' preference were recorded. Statistical analysis of time and errors between groups was conducted with a Student's t test (using independent samples) and the Mann-Whitney test.
In all 3 groups, the average time with the 2D system was significantly reduced after having used the 3D system ( P < .05). In the postexercise questionnaire, two thirds of participants showed a preference for using the 3D system.
This study suggests that the 3D system may improve the learning curve and that learning from the 3D system is transferable to the 2D environment. Additionally, the majority of participants prefer 3D equipment.
通常腹腔镜手术是通过二维（2D）图像系统和多端口方法进行的。为了克服缺乏深度感知的问题，新的三维（3D）系统应运而生，其额外优势是提供立体视觉。为了进一步减少手术相关创伤，正在开发新的微创手术技术，如单孔腹腔镜手术（LESS）。本研究的目的是比较LESS手术中二维和三维腹腔镜系统。
所有参与者均选自腹腔镜手术经验不同水平的人群，包括10名新手、7名中级水平者和10名专家。所有参与者均无LESS手术经验。参与者被随机选择开始使用二维或三维腹腔镜系统。练习内容是在固定距离腹腔镜的辅助下，通过单孔腹腔镜手术端口进行离体猪胆囊切除术。记录错误情况、时间和参与者的偏好。采用学生t检验（独立样本）和曼-惠特尼检验对两组之间的时间和错误进行统计分析。
在所有三组中，使用三维系统后，二维系统的平均时间均显著缩短（P <.05）。在练习后的问卷调查中，三分之二的参与者表示更喜欢使用三维系统。
本研究表明，三维系统可能会改善学习曲线，并且从三维系统的学习可转移到二维环境中。此外，大多数参与者更喜欢三维设备。
