title: Three-dimensional Technology Facilitates Surgical Performance of Novice Laparoscopy Surgeons: A Quantitative Assessment on a Porcine Kidney Model.
abstract: To determine whether the use of 3-dimensional (3D) imaging translates into a better surgical performance of naïve urologic laparoscopic surgeons during pyeloplasty (PY) and partial nephrectomy (PN) procedures.
  
  
  
  Eighteen surgeons without any previous laparoscopic experience were randomly assigned to perform PY and PN in a porcine model using initially 2-dimensional (2D) and 3D laparoscopy. A surgical performance score was rated by an "expert" tutor through a modified 5-item global rating scale contemplating operative field view, bimanual dexterity, efficiency, tissue handling, and autonomy. Overall surgical time, complications, subjective perception of participating surgeons, and inconveniences related to the 3D vision were recorded.
  
  
  
  No difference in terms if operative time was found between 2D or 3D laparoscopy for both the PY (P = .51) and the PN (P = .28) procedures. A better rate in terms of surgical performance score was noted by the tutors when the study participants were using 3D vs 2D, for both PY (3.6 [0.8] vs 3.0 [0.4]; P = .034) and PN (3.6 [0.51] vs 3.15 [0.63]; P = .001). No complications occurred in any of the procedures. Most (77.2%) of the participating naïve laparoscopic surgeons had the perception that 3D laparoscopy was overall easier than 2D. Headache (18.1%), nausea (18.1%), and visual disturbance (18.1%) were the most common issues reported by the surgeons during 3D procedures.
  
  
  
  Despite the absence of translation in a shorter operative time, the use of 3D technology seems to facilitate the surgical performance of naïve surgeons during laparoscopic kidney procedures on a porcine model.
authors.affiliation: Department of Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.affiliation: Department of Urology, University Hospitals, Cleveland, OH; Department of Urology, Second University, Napoli, Italy. Electronic address: riccardo.autorino@uhhospitals.org.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Department of Urology, AMC, Amsterdam, The Netherlands.
authors.forename: M Pilar
authors.initials: MP
authors.lastname: Laguna
authors.affiliation: Department of Urology, Second University, Napoli, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.affiliation: Department of Urology, Ege University School of Medicine, Izmir, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Turna
authors.affiliation: Department of Urology, Institute Mutualiste Montsouris, Paris, France.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.affiliation: Department of Urology, Second University, Napoli, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Quattrone
authors.affiliation: Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Dias
authors.affiliation: Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Mota
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giampoalo
authors.initials: G
authors.lastname: Bianchi
authors.affiliation: Department of Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.affiliation: Department of Urology, SLK-Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
authors.affiliation: Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.
authors.forename: Estevao
authors.initials: E
authors.lastname: Lima
mesh_terms: D000328:Adult; D000818:Animals; D002983:Clinical Competence; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000193:education*; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D013552:Swine