S. Kanaji1, M. Nishi1, H. Harada1, M. Yamamoto1, K. Kanemitsu1, K. Yamashita1, T. Oshikiri1, Y. Sumi1, T. Nakamura1, S. Suzuki1, Y. Kakeji1 1Kobe University Graduate School Of Medicine,Division Of Gastrointestinal Surgery, Department Of Surgery,Kobe, HYOGO, Japan
Introduction: One of the major limitations of conventional laparoscopy is lack of depth perception. Introduction of 3D display might remove this technical obstacle and improve laparoscopic skills. There has been some reports demonstrated benefit of 3D imaging during simple laparoscopic procedure, such as cholecystectomy. It is still unclear whether 3D display also improve surgeons’ skill in complicated laparoscopic surgery. We attempt to analyze the effect of 3D technology on operative performance during laparoscopic total gastrectomy (LTG) for gastric cancer and to assess its advantages over 2D laparoscopy.
Methods: Consecutive 18 patients (3D group: n=10, 2D group: n=8) who underwent LTG followed by esophagojejunostomy with overlap method were analyzed. All cases were operated by same established manner by a single surgeon experienced in laparoscopic gastric surgery. The surgical outcomes were compared between 3D and 2D group. Further, we compared 3D with 2D in each laparoscopic scenes (lymphadenectomy and reconstruction) by the performance time, the frequency of any bleeding required hemostasis, and the frequency of reset surgical view by assistant’ forceps.
Results: All surgeries were completed without any complications. The total laparoscopic time was shorter in 3D group than 2D group (158 vs 195 min, P=0.045) and total blood loss was almost the same (86 vs 54 g, P=0.27) in between 2 group. The operative time was shorter in 3D group than 2D group during lymphadenectomy around celiac artery (26 vs 41 min, P<0.01) and esophagojejunostomy with overlap method (30 vs 49 min, P=0.04). The frequency of reset surgical view by assistant’ forceps were fewer only in lymphadenectomy around celiac artery (n=5.6 vs n=8.6, P<0.01).
Conclusion: Our results showed that LTG using the stereoscopic vision of 3D display can be done in shorter operative time. We consider LTG using 3D display is useful due to improve the surgical skill during difficult situation, such as lymphadenectomy around celiac artery where need handling in tangential view, and reconstruction using suturing technique in narrow space.