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      3D technology in laparoscopy

      Using 3D dimension in the operating room

      Laparoscopy has revolutionised surgery compared to open procedures, especially in terms of reducing complications. Laparoscopy can be improved through innovative technology such as 3D laparoscopy.

      3D visualisation systems in laparoscopy

      Laparoscopy places particular demands on the surgeon who has to navigate and operate in three-dimensional space using a two-dimensional image, with the loss of depth perception. Correspondingly, visual perception is the main challenge for successful laparoscopic surgery. [1]

      One solution to this problem are three-dimensional visualisation methods. Such systems were already developed in the 1990s, but these were still limited in terms of image resolution and viewing conditions, and were unaffordable for most hospitals. Meaning, 3D systems could not be implemented in the operating room at first. However, since then, innovation has been driving the advancement of laparoscopy: more recent 3D visualisation systems provide excellent image quality at more attractive prices. Studies show that in particular the 3D systems are superior to 2D solutions in terms of performance. [2]

      3D laparoscopy: Shorter operating times, fewer errors, fewer complications

      3D techniques help make laparoscopic operations faster and safer. According to a recent systematic review, the majority of studies where 2D and 3D techniques were compared, showed that the respective operative task was solved significantly faster and with fewer errors when the 3D system was used in model experiments or patients. [2] The use of 3D in laparoscopy supports shorter surgery times, shorter hospitalisation and less postoperative pain compared to 2D. [3] The advantages of 3D laparoscopy are particularly important for complex tasks. [4], [5] In some operations, 3D does not significantly accelerate the operation, but improves perception of depth and enhanced precision. [6] The result: Surgeons appreciate 3D laparoscopy and would prefer a 3D system. [7]

      3D laparoscopy: providing a better experience for all surgeons 

      3D systems measurably improve the spatial orientation as well as hand-eye coordination [7] and are perceived as less tiring. [2] This is particularly beneficial for training surgeons: Thanks to better spatial orientation, they manage to learn a new surgical technique faster than with conventional laparoscopy. [8], [9] With 3D, a training surgeon operates just as fast as an experienced surgeon with 2D. [10] But also experienced laparoscopists benefit from 3D technology and perform the tasks faster, [11] with fewer missed grasps [12] and fewer complications. [13]

      Hence, 3D laparoscopy offers measurable advantages over the standard 2D systems: better depth perception, faster operation and higher patient satisfaction. Is your hospital already benefitting from these advantages?

      3D versus 2D laparoscopy: The verdict is clear

      When new medical or technical innovations find their way into general practice, initially there is often not a clear consensus regarding their advantages. The comparison between 3D and 2D laparoscopy, however, has yielded a clear judgment in favor of the 3D technology.

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      EinsteinVision® 3.0 FI

      3D camera system in laparoscopic surgery

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      [1] Way LW, Stewart L, Gantert W et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Annals of surgery 2003; 237: 460-9.

      [2] Sørensen SM, Savran MM, Konge L et al. Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review. Surgical endoscopy 2016; 30: 11-23.

      [3] Westhofen S, Conradi L, Deuse T et al. A matched pairs analysis of non-rib-spreading, fully endoscopic, mini-incision technique versus conventional mini-thoracotomy for mitral valve repair. European journal of cardio-thoracic surgery: official journal of the European Association for Cardiothoracic Surgery 2016; 50: 1181-7.

      [4] Wagner OJ, Hagen M, Kurmann A et al. Three-dimensional vision enhances task performance independently of the surgical method. Surgical endoscopy 2012; 26: 2961-8.

      [5] Kinoshita H, Nakagawa K, Usui Y et al. High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems. Surgical endoscopy 2015; 29: 2203-9.

      [6] Agrusa A, di Buono G, Chianetta D et al. Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: A case-control study. International journal of surgery (London, England) 2016; 28 Suppl 1: S114-7.

      [7] Tuschy B, Berlit S, Brade J et al. Full High-definition three-dimensional gynaecological laparoscopy--clinical assessment of a new robot-assisted device. In vivo (Athens, Greece) 2014; 28: 111-5.

      [8] Cologne KG, Zehetner J, Liwanag L et al. Three-dimensional Laparoscopy: Does Improved Visualization Decrease the Learning Curve Among Trainees in Advanced Procedures? Surgical laparoscopy, endoscopy & percutaneous techniques 2015; 25: 321-3.

      [9] Usta TA, Ozkaynak A, Kovalak E et al. An assessment of the new generation three-dimensional high definition laparoscopic vision system on surgical skills: a randomized prospective study. Surgical endoscopy 2015; 29: 2305-13.

      [10] Folaranmi SE, Partridge RW, Brennan PM et al. Does a 3D Image Improve Laparoscopic Motor Skills? Journal of laparoendoscopic & advanced surgical techniques Part A 2016; 26: 671-3.

      [11] Wilhelm D, Reiser S, Kohn N et al. Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D. Surgical endoscopy 2014; 28: 2387-97.

      [12] Honeck P, Wendt-Nordahl G, Rassweiler J et al. Three-dimensional laparoscopic imaging improves surgical performance on standardized ex-vivo laparoscopic tasks. Journal of endourology 2012; 26: 1085-8.

      [13] Padin EM, Santos RS, Fernandez SG et al. Impact of Three-Dimensional Laparoscopy in a Bariatric Surgery Program: Influence in the Learning Curve. Obesity surgery 2017; 27: 2552-6.

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