Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
Department of Urology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
J Endourol. 2021 Feb;35(2):123-137. doi: 10.1089/end.2020.0284. Epub 2020 Sep 9.
The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Three-dimensional laparoscopic systems essentially advance surgical performance in less-experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.
本研究旨在比较三维（3D）视觉系统与传统二维系统在腹腔镜泌尿外科手术中的应用，分析在手术性能和外科医生的人体工程学方面引入这种医疗技术的益处、局限性和影响。我们在电子数据库（PubMed 和 EMBASE）中进行了系统评价和结构化文献检索，检索时间截至 2019 年 8 月，且不限制语言。纳入的研究为腹腔镜泌尿外科手术中 3D 可视化技术的观察性比较研究、随机对照试验和前瞻性研究。提取并分析相关数据。共获得 25 篇文章，其中 4 篇为患者临床研究，2 篇为实验动物模型研究，其余 19 篇为模拟环境研究。关于欧洲基本腹腔镜泌尿外科技能培训计划，使用这两种成像系统时，执行时间没有显著差异。3D 视觉可显著减少肾盂成形术和根治性肾切除术的手术时间。此外，在肾上腺切除术、保肾肾切除术、根治性肾切除术、单纯肾切除术和肾盂成形术中，使用 3D 视觉时，报道的失血量也有所减少。在人体工程学方面，研究普遍描述了两种可视化系统的副作用（头痛、恶心、眼疲劳）没有差异。与传统腹腔镜相比，外科医生报告 3D 视觉可降低工作负荷和压力。三维腹腔镜系统本质上提高了经验不足的腹腔镜外科医生的手术性能。三维腹腔镜可改善手术时间，这对于涉及体内结扎和缝合的特定手术程序很重要。在外科医生的人体工程学方面的结果表明，3D 视觉下深度知觉更好，压力和工作负荷降低，潜在副作用没有差异。
