Comparison of two- and three-dimensional display for performance of laparoscopic total gastrectomy for gastric cancer.
OBJECTIVE
Introduction of three-dimensional (3D) display might remove technical obstacles of laparoscopic surgery and improve laparoscopic skills. We analyzed the effect of 3D technology on operative performance during laparoscopic total gastrectomy (LTG) for gastric cancer and assessed its advantages over two-dimensional (2D) laparoscopy.


METHODS
This study included 30 consecutive surgeries of LTG with esophagojejunostomy by the overlap method performed (3D group, n = 15, 2D group, n = 15). The surgical outcomes were compared between the 3D and 2D groups. Further, we compared the performance time, the frequency of bleeding requiring hemostasis, and the frequency of remaking the surgical view by the assistant's forceps in each laparoscopic scene between the 3D and 2D groups.


RESULTS
All surgeries were completed without any complications. The total time of pure laparoscopic scenes was shorter in the 3D than 2D group (154.2 vs. 182.7 min, P = 0.026), and total blood loss was almost the same (10 vs. 20 g, P = 0.195). The operative time during lymphadenectomy in scenes 6 and 7 were significantly shorter in the 3D than the 2D group (scene 6, 13.5 vs. 17.5 min, P = 0.003, and scene 7, 12.4 vs. 18.4, P = 0.025) and esophagojejunostomy (30.3 vs. 39.4 min, P = 0.008). The frequency of tissue exposure by the assistant was significantly less in the 3D group than the 2D group in scenes 6 and 7 (scene 6, n = 3.0 vs. 4.0, P = 0.006, and scene 7, n = 3.0 vs. 4.0, P = 0.017).


CONCLUSIONS
3D display is useful due to improvement of surgical skill during difficult situations such as lymphadenectomy around the celiac artery, which requires handling in the tangential view, and reconstruction using the suturing technique in a narrow space.
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan. kanashin@med.kobe-u.ac.jp.
Shingo
S
Kanaji
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Satoshi
S
Suzuki
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Hitoshi
H
Harada
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Masayasu
M
Nishi
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Masashi
M
Yamamoto
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Takeru
T
Matsuda
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Taro
T
Oshikiri
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Tetsu
T
Nakamura
Department of Gastroenterogical Surgery, Hyogo Cancer Center, Hyogo, Japan.
Yasuhiro
Y
Fujino
Department of Gastroenterogical Surgery, Hyogo Cancer Center, Hyogo, Japan.
Masahiro
M
Tominaga
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Yoshihiro
Y
Kakeji
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004946:Esophagostomy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*
2D laparoscopy; 3D laparoscopy; Esophagojejunostomy by the overlap method; Gastric cancer; Laparoscopic total gastrectomy