title: Three-Dimensional Reconstruction of Preoperative Imaging Improves Surgical Success in Laparoscopy.
abstract: OBJECTIVE
  To show the benefit of three-dimensional (3D) reconstructions of preoperative imaging for surgical performance.
  
  
  METHODS
  A laparoscopic training environment with 15 hidden lymph nodes was designed. Three of them were marked with radiographic contrast agent and were only distinguishable from unmarked nodes via CT imaging. Thirty-six surgeons were divided into two groups. To group 1 the unprocessed CT data were shown. Group 2 was additionally shown a 3D reconstruction of the anatomy. Time of studying the imaging was recorded. All surgeons had to find the three target lymph nodes laparoscopically. Time to fulfill this task and errors was measured. Afterward, the 3D reconstruction was also shown to group 1. Then, all participants completed a questionnaire. Furthermore, 3D reconstructions were used in 15 clinical cases of partial nephrectomy or lymphadenectomy, and surgeons' opinion was evaluated with an additional questionnaire. The imaging and 3D reconstructions were available on a mobile device.
  
  
  RESULTS
  The time of studying the imaging to gain confidence was significantly shorter with the 3D reconstruction. Laparoscopic intervention time was shortened and errors were reduced significantly within group 2. The clinical application of 3D reconstructions in difficult cases was believed to be helpful.
  
  
  CONCLUSIONS
  3D reconstructions of preoperative imaging lead to better surgical performance in a difficult laparoscopic training environment. Surgeons gain a 3D impression of patients' individual anatomy easier, faster, and more reliable. Providing 3D reconstructions previous to surgery should be routinely implemented for patients with complex anatomical situations.
authors.affiliation: 1 Department of Urology, University of Heidelberg , Heidelberg, Germany .
authors.forename: Tobias
authors.initials: T
authors.lastname: Simpfendörfer
authors.affiliation: 1 Department of Urology, University of Heidelberg , Heidelberg, Germany .|2 Department of Urology, First Affiliated Hospital of Dalian Medical University , Dalian, China .
authors.forename: Ziyao
authors.initials: Z
authors.lastname: Li
authors.affiliation: 1 Department of Urology, University of Heidelberg , Heidelberg, Germany .
authors.forename: Claudia
authors.initials: C
authors.lastname: Gasch
authors.affiliation: 3 Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Frederik
authors.initials: F
authors.lastname: Drosdzol
authors.affiliation: 3 Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Markus
authors.initials: M
authors.lastname: Fangerau
authors.affiliation: 4 mbits Imaging GmbH, Heidelberg, Germany .
authors.forename: Michael
authors.initials: M
authors.lastname: Müller
authors.affiliation: 3 Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Lena
authors.initials: L
authors.lastname: Maier-Hein
authors.affiliation: 1 Department of Urology, University of Heidelberg , Heidelberg, Germany .
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: 1 Department of Urology, University of Heidelberg , Heidelberg, Germany .
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D066231:Surgeons; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: 3D imaging; 3D reconstruction; laparoscopic surgery; laparoscopic training; virtual reality