3D versus 2D Laparoscopy

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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. There seems to be further potential for improvement merely in regard to questions of how surgeons become familiar with the new technology and of image processing speed. The advantages of 3D laparoscopy are particularly convincing in connection with better depth perception and a consequent reduction of risk in surgical procedures. The 3D procedure is also very efficient from a hospital management standpoint.

Laparoscopy is used to enable the visualization of organs and structures in the abdominal cavity. It is employed for diagnostic purposes and especially for performing surgery. The minimally invasive procedure results in less trauma during surgery and reduced postoperative pain. In addition, it lowers the risk of infection and avoids more extensive adhesions in the tissue. The comparison between 3D and 2D procedures was already an important developmental question several years ago and was investigated in various animal-based studies. [1]

3D visualization systems have been in existence for almost two decades, but the literature is now speaking of a renaissance in 3D imaging that has been underway for the last few years. More and more prominent manufacturers are bringing 3D systems to the market. In addition, critical enhancements in these systems have also led to growing demand for the technology, which also has had a positive effect on the prices. Foremost among these enhancements is the improved imaging they now provide as a result of expanded processing power in the systems – a development that also has occurred in digital microscopy. For visualizations of this quality twenty years ago, much larger and more expensive devices would have been required. [2] 3D laparoscopy systems are now available at acceptable prices. [3] A look in hospitals today shows that 3D laparoscopy is becoming more and more popular – not least because of how easy it is to learn, even for less experienced surgeons. [4]

Expanded range of operations and greater safety

The expanded range of operations that are being performed laparoscopically is most of all attributable to the improved imaging from the 3D systems. A recent clinical study by Baum et al. [5] investigated the effects of 3D laparoscopy on the efficacy and safety of gynecological procedures. Significant advantages were found in suturing and cutting of anatomical structures when using 3D visualization. In comparison to 2D laparoscopy, the surgeons found the representation of spatial depth particularly advantageous, an important reason for the improved safety levels in the operative procedures. The depiction of retroperitoneal neural structures was significantly improved. Improvements in the visualization of the uterus, ureter and blood vessels were not so pronounced. Despite this, Baum et al. draw a highly positive conclusion: Working with 3D laparoscopy provides surgeons with big advantages in comparison to 2D devices. The depiction of space shown in the images simply resembles the actual anatomy more closely. [5]

Depth perception – A big plus

Other studies come to similar conclusions. In a comparative study, 53 patients were treated for various surgical indications (including ovarian cyst, hernia and cholelithiasis). One group was operated using 3D laparoscopy, the other using 2D technology. The largest disadvantage of 2D laparoscopy is the lack of depth perception. This encumbers surgeons during operative procedures and can have a negative effect on safety. [6] The 3D group had a distinct advantage with significantly shorter time periods for the operations. The physicians cited the superior image quality particularly in respect to depth perception as the decisive factor for the more rapid procedures. [6]

Other advantages of the 3D technology are the good hand-eye coordination that it affords as well as increased precision. This allows surgeons to work more exactly and with fewer errors and to separate even exceedingly fine tissue structures. Less experienced surgeons benefit especially from these advantages. [7] They can learn the operations and the related anatomical features more quickly and effectively. The financial benefits for hospitals are obvious: In some cases, significantly shorter operation times reduce the amount of anesthetics that are required. In addition, existing laparoscopy instruments, for example all those that have a straight design, can also be used with the 3D technology. This lowers the investment as well as the maintenance costs. [7]

Reduced mortality

Even more important, however, are the reduced rates of mortality associated with 3D laparoscopy. It is possible to release patients into postoperative care in a better state of health. [6] Possible disadvantages have more to do with the subjective habituation of surgeons to the view through the 3D glasses as well as with even faster data processing. All in all, the advantages of 3D laparoscopy are unmistakable. Apparently this was already foreseeable prior to the technology's full establishment in regular clinical practice. Thus it can be read on page 247 in the book of the 51st Congress of the German Society for Gynecology and Obstetrics: "If one leaves financial considerations aside, there is no way to understand why all surgeons do not immediately switch over to three-dimensional imaging since these are the images which we all are accustomed to from daily life." This congress took place from 1-5 October 1996. [4]

[1] Beger HG, Schwarz A, Brückner UB, Hartel W. Forschung in der Chirurgie; Konzepte, Organisation, Schwerpunkte: Eine Bestandsaufnahme – Universitäre Einrichtungen. Berlin, Heidelberg, Springer-Verlag, 1997:359.
[2] Rosahl S. Interviewed by: Römer GC. 2017 Nov 08.
[3] Jähne J, Königsrainer A, Schröder W, Südkamp NP. Was gibt es Neues in der Chirurgie? Jahresband 2013: Berichte zur chirurgischen Weiter- und Fortbildung. Landsberg, ecomed MEDIZIN, 2013:455.
[4] Künzel W, Diedrich K, Hohmann M. 51. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe. Dresden 1.-5. Oktober 1996, Berlin,Heidelberg, Springer-Verlag, 1997:247.
[5] Baum S, Sillem M, Ney JT, Baum A, Friedrich M, Radosa J. What Are the Advantages of 3D Cameras in Gynaecological Laparoscopy? Geburtshilfe Frauenheilkd. 2017 Jan; 77(1):45-51.
[6] Sahu D, Mathew MJ, Reddy PK. 3D Laparoscopy – Help or Hype; Initial Experience of A Tertiary Health Centre. J Clin Diagn Res. 2014 Jul; 8(7):NC01-NC03.
[7] Sinha RY, Raje SR, Rao GA. Three-dimensional laparoscopy: Principles and practice. J Minim Access Surg. 2017 Jul-Sep; 13(3):165-9.

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