title: How Technology Can Impact Surgeon Performance: A Randomized Trial Comparing 3-Dimensional versus 2-Dimensional Laparoscopy in Gynecology Oncology.
abstract: This randomized clinical trial (Canadian Task Force classification I) aimed to compare 2-dimension (2-D) versus 3-dimensional (3-D) laparoscopic hysterectomy and pelvic lymphadenectomy in endometrial and cervical cancer patients. Between December 2014 and March 2015, 90 patients were enrolled: 29 (32.2%) with early or locally advanced cervical cancer after neoadjuvant treatment and 61 (67.8%) with early-stage endometrial cancer. Patients were randomly assigned to undergo 2-D (Group A, n = 48 [53.3%]) or 3-D (Group B, n = 42 [46.7%)]) laparoscopy. Baseline characteristics were superimposable in the 2 groups. Median operative time was similar in the 2 groups. Median estimated blood loss during lymphadenectomy was significantly lower in Group B than in Group A (38 mL [range, 0-450] vs 65 mL [range, 0-200]; p = .033). In cervical cancer patients operative time of pelvic lymphadenectomy performed by "novice" surgeons (those with <10 procedures performed) was statistically significantly lower in Group B (p = .047). No differences in perioperative outcomes and postoperative complications were observed between the 2 groups. The 2-D and 3-D systems can be used safely in laparoscopic hysterectomy. However, the 3-D system could provide key benefits to intraoperative techniques and postoperative outcomes in reducing operative time for "expert" surgeons and in enhancing surgical precision for "novice" surgeons.
authors.affiliation: Department of Medicine and Aging Sciences, University "G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: francesco.fanfani@unich.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Rossitto
authors.affiliation: Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Restaino
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Maggiore della Carità, Novara, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ercoli
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital "Paolo Giaccone", Palermo, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Monterossi
authors.affiliation: Medicine Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D066231:Surgeons; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
keywords: Cervical cancer; Endometrial cancer; Three-dimensional laparoscopic