title: 3-Dimensional (3D) laparoscopy improves operating time in small spaces without impact on hemodynamics and psychomental stress parameters of the surgeon.
abstract: OBJECTIVE
  Three-dimensional (3D) imaging, a recent technical innovation in laparoscopic surgery, has been postulated to enhance depth perception and facilitate operations. However, it has never been evaluated in conditions where the focus is close to the optical system. Thus, it is unclear whether 3D cameras can improve laparoscopic surgical performance in neonates and infants. We tested 3D versus two-dimensional (2D) vision during laparoscopic surgery in rabbits, mimicking the size of a neonatal patient.
  
  
  METHODS
  Cadaver New Zealand white rabbits (mean weight 2,755 g) were operated by two surgeons experienced in 2D laparoscopic surgery and two surgical residents (with basic skills in 2D laparoscopy). All surgeons had never performed 3D laparoscopic surgery. Animals underwent six operations: Nissen fundoplication, small bowel anastomosis, and closure of a diaphragmatic defect using either 2D or 3D. Primary endpoint was cumulative operating time and operating time of each operation. Secondary endpoints included the hemodynamic response and psychomental stress level of the surgeons. Finally, subjective data on depth perception were assessed by questionnaires.
  
  
  RESULTS
  Cumulative operating time of all three types of operations was significantly shorter with 3D laparoscopy in experts (3D: 23.01 ± 5.65 min vs 2D: 29.51 ± 7.51 min, p < 0.01) and residents (3D: 27.95 ± 3.69 min vs 2D: 33.95 ± 6.21 min, p < 0.05). This effect could be shown for each operation in the expert group and the Nissen fundoplication in the resident group. There were no differences in the hemodynamic response as well as the psychomental stress level between 2D and 3D imaging. 3D provided better depth perception.
  
  
  CONCLUSIONS
  3D laparoscopy in small spaces is associated with a significant shorter operating time. It induces no additional physical or psychomental stress in surgeons naive to 3D imaging. 3D may therefore facilitate minimal invasive surgery in neonates and infants.
authors: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors: Xiaoyan
authors: X
authors: Feng
authors: Anna
authors: A
authors: Morandi
authors: Martin
authors: M
authors: Boehne
authors: Tawan
authors: T
authors: Imvised
authors: Benno M
authors: BM
authors: Ure
authors: M
authors: M
authors: Ure Benno
authors: Joachim F
authors: JF
authors: Kuebler
authors: Martin
authors: M
authors: Lacher
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D002983:Clinical Competence; D003867:Depth Perception; D003964:Diaphragm / Q000601:surgery; D018662:Fundoplication; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D007231:Infant, Newborn; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D061646:Operative Time; D011817:Rabbits; D013315:Stress, Psychological; D066231:Surgeons / Q000523:psychology*; D011795:Surveys and Questionnaires