Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
Department of Surgery, Hospital Italiano de Buenos Aires Hospital, Buenos Aires, Argentina.
HPB (Oxford). 2019 Aug;21(8):1087-1094. doi: 10.1016/j.hpb.2019.04.012. Epub 2019 May 10.
It is currently unclear what the added value is of 3D-laparoscopy during pancreatic and biliary surgery. 3D-laparoscopy could improve procedure time and/or surgical performance, for instance in demanding anastomoses such as pancreatico- and hepaticojejunostomy. The impact of 3D-laparoscopy could be negligible in more experienced surgeons.
We conducted a randomized controlled cross-over trial including 20 expert laparoscopic surgeons and 20 surgical residents from 9 countries (Argentina, Estonia, Israel, Italy, the Netherlands, South Africa, Spain, UK, USA). All participants performed a pancreaticojejunostomy (PJ) and a hepaticojejunostomy (HJ) using 3D- and 2D-laparoscopy on biotissue organ models according to the Pittsburgh method. Primary endpoint was the time required to complete both anastomoses. Secondary endpoint was the objective structured assessment of technical skill (OSATS; range 12-60) rating. Observers were blinded for 3D/2D and expertise.
A total of 40 participants completed 144 PJs and HJs. 3D-laparoscopy reduced the operative time with 15.5 min (95%CI 10.2-24.5 min), from 81.0 to 64.4 min, p = 0.001. This reduction was observed for both experts and residents (13.0 vs 22.2 min, intergroup significance p = 0.354). The OSATS improved with 5.1 points, SD ± 6.3, with 3D-laparoscopy, p = 0.001. This improvement was observed for both experts and residents (4.6 vs 5.6 points, p = 0.519). Of all participants, 37/39 participants stated to prefer 3D laparoscopy whereas 14/39 reported side effects. Minor side effects were reported by 10/39 participants whereas 2/39 participants reported severe side effects (both severe eye strain).
3D-laparoscopy, as compared to 2D-laparoscopy, reduced the operative time and improved surgical performance for PJ and HJ anastomoses in both experts and residents with mostly minor side effects.
目前尚不清楚 3D 腹腔镜在胰腺和胆道手术中的附加价值。3D 腹腔镜可能会缩短手术时间和/或提高手术效果，例如在胰肠吻合术和胆肠吻合术等复杂吻合术中。在经验丰富的外科医生中，3D 腹腔镜的影响可能微不足道。
我们进行了一项随机对照交叉试验，纳入了来自 9 个国家（阿根廷、爱沙尼亚、以色列、意大利、荷兰、南非、西班牙、英国和美国）的 20 名专家腹腔镜外科医生和 20 名外科住院医师。所有参与者均使用 Pittsburgh 方法在生物组织器官模型上使用 3D 和 2D 腹腔镜进行胰肠吻合术（PJ）和胆肠吻合术（HJ）。主要终点是完成两种吻合所需的时间。次要终点是客观结构化手术技能评估（OSATS；范围 12-60）评分。观察者对 3D/2D 和专业知识均不知情。
共有 40 名参与者完成了 144 例 PJ 和 HJ。3D 腹腔镜将手术时间缩短了 15.5 分钟（95%CI 10.2-24.5 分钟），从 81.0 分钟缩短至 64.4 分钟，p=0.001。这种减少在专家和住院医师中均可见（13.0 分钟与 22.2 分钟，组间差异无统计学意义 p=0.354）。3D 腹腔镜使 OSATS 评分提高了 5.1 分，标准偏差±6.3，p=0.001。这一改善在专家和住院医师中均可见（4.6 分与 5.6 分，p=0.519）。在所有参与者中，37/39 名参与者表示更喜欢 3D 腹腔镜，而 14/39 名参与者报告了副作用。10/39 名参与者报告了轻微副作用，而 2/39 名参与者报告了严重副作用（均为严重眼疲劳）。
与 2D 腹腔镜相比，3D 腹腔镜可缩短 PJ 和 HJ 吻合术的手术时间，并提高手术效果，专家和住院医师均可获益，且副作用多为轻微。
