Unleash 3D: 3D Laparoscopy Provides a Benchmark in Surgical Precision and Efficiency

03/07/2022

Despite laparoscopy being a vital technique used in a broad range of surgical disciplines, conventional 2D laparoscopes provide only monocular imaging of the operative field – making accurate depth perception challenging. To overcome these limitations, 3D laparoscopes provide superior image quality and enable surgeons to accurately identify even small anatomical structures. 3D laparoscopes provide surgeons with a view that closely resembles that of open surgery. By providing a wide field of view and high-quality images, 3D laparoscopes reduce operating times and enhance patient safety and surgeon comfort. With a suite of advanced imaging features, 3D laparoscopes such as ENDOEYE 3D from Olympus form a powerful clinical solution for multiple surgical specialties, including gastrointestinal, urology, gynecology, bariatrics and many others. In this article, we discuss the advantages of 3D laparoscopy over conventional 2D laparoscopy and open surgery and highlight how the use of 3D devices can help reduce operating times, improve surgeon experience and patient outcomes, and shorten the learning curve for a range of laparoscopic techniques.

General Surgery, Gynecology, Urology
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3D video laparoscopes streamline surgery

For laparoscopic procedures to be as safe and efficient as possible, surgeons must be able to judge the distance to anatomical structures with high accuracy. However, as the images produced with conventional 2D laparoscopes are often flat, identifying surgical planes can be challenging and time-consuming. The development of 3D laparoscopes made huge leaps towards overcoming these limitations, providing surgeons with a more detailed and immersive view than was previously possible.

In an interview, Prof. Antonio Lacy, Chief of GI surgery at Hospital Clinic Barcelona, explained that the time saved as a result of the improved depth of 3D vision was one of the most convincing advantages when switching from 2D to 3D. In his experience, operating time can be reduced by about 25% per procedure with a 3D laparoscope.

Hear more about the benefits of 3D laparoscopy here

The increased precision of 3D laparoscopes enables surgeons to navigate the surgical plane more effectively and substantially reduces the time spent in the operating room (OR). Studies have shown that the use of 3D laparoscopes has reduced the duration of multiple surgical procedures including laparoscopic liver resectioning 1 , bariatric surgery 2 and vesicourethral anastomosis 3 . Minimizing the time spent in the operating room is not only safer for patients 4 but also lightens the load on surgeons and healthcare systems as a whole, where large procedural backlogs due to the COVID-19 pandemic are a significant cause for concern.

In laparoscopic procedures, achieving a lateral view of the anatomical target requires rotation of the laparoscope. However, in conventional 3D devices this results in the simultaneous rotation of the surgical image – making orientation within the operative field challenging. With ENDOEYE 3D, surgeons can achieve a 30-degree lateral view without loss of horizon, providing a more intuitive surgical view and greater procedural efficiency.

In addition to the rigid ENDOEYE 3D, Olympus also offers ENDOEYE FLEX 3D – an advanced 3D laparoscope with a flexible tip, that provides unprecedented manoeuvrability for procedures conducted in small spaces. ENDOEYE FLEX 3D maintains a horizontal image even at 100-degree angulation, expanding the surgical view that can be achieved and enhancing the accuracy of difficult techniques including single port surgery or transnasal endoscopic microsurgery 5 .

3D laparoscopes are also increasing efficiency in other areas. For example, Rigid ENDOEYE 3D is fully autoclavable, removing the need for draping, assembly and disassembling – providing a more hygienic and efficient solution for laparoscope reprocessing. Being a portable plug and play device also means ENDOEYE 3D is simple to set up and use, helping support staff and surgeons prepare for surgery more rapidly.

ENDOEYE FLEX 3D and ENDOEYE 3D Rigid

Encouraging better patient outcomes with 3D video laparoscopes

When it comes to complex laparoscopic procedures, greater precision equals greater patient safety. By enabling surgeons to easily identify small anatomical structures, 3D laparoscopes can reduce blood loss during procedures including total laparoscopic hysterectomy 8 and pelvic lymphadenectomy 9 .

Further evidence for improved patient outcomes with 3D laparoscopy comes from recent studies which directly compared 2D and 3D techniques for procedures including bariatric surgery, gastrectomies and prostatectomies 2,3,7 . For difficult laparoscopic techniques such as suturing, 3D techniques resulted in significantly fewer complications 3,6 , shorter patient stays in hospital l2,10 and an increased quality of life – even at 12 months post-surgery 11 . Many of these important benefits were attributed to the enhanced image quality provided by 3D laparoscopes. This assessment is also shared by Jurriaan Tuynman MD, PhD who has been working as a Colorectal Surgeon at Amsterdam University Medical Center, VUmc for six years. He describes 3D vision as an extra step in safety creation.

Jurriaan Tuynman MD, PhD describes 3D vision as an extra step in safety creation

3D Laparoscopes such as ENDOEYE also offer 30-degree image rotation without loss of horizon – making navigation of the surgical plane easier and safer for patients. The Chip-on-the-Tip technology of ENDOEYE also eliminates the ‘honeycomb’ video appearance associated with scopes that use fiber optics, resulting in exceptional image clarity throughout the whole procedure. With this technology, all objects between 2.5 and 12 cm from the tip are in constant focus – enabling better visualization of structures in the operative field and improved surgical precision.

Technological innovation can enhance surgeon expertise and experience

For surgeons that regularly conduct a high volume of laparoscopic procedures, using devices that maximize detail is crucial to help prevent exhaustion. While conventional 2D procedures can be lengthy and difficult, a recent systematic review of studies using 3D imaging systems showed that these devices lower the cognitive workload required during surgery – reducing surgeon fatigue 6 .

Studies have also shown 3D laparoscopes to be highly effective for specific techniques. The exceptional depth perception and accurate color reproduction provided by 3D laparoscopes can boost the skill of surgeons performing difficult procedures such as suture reconstruction or lymphadenectomy in confined spaces 7 . These improvements in expertise are also independent of surgeon experience, and 3D devices are proven to enhance the surgical precision of both novice and experienced surgeons alike 8,9 .

Sharing his personal experience, Prof. Giovanni Scambia, chairman of the Department of Gynecology and Obstetrics at the Catholic University Policlinico Gemelli, states that “The 3D system is very, very effective and it allows us to easily perform very complex procedures.” In his experience, using the 3D system, especially in a complex situation, results in more confidence and less fatigue.

Prof. Giovanni Scambia Shared his personal experience with the The 3D system

3D video laparoscopes are a powerful tool for surgical training

The high image quality and heads-up display provided by 3D devices offer important benefits that can substantially shorten the learning curve for surgeons at various skill levels. For example, when using 3D laparoscopes for standard box trainer tasks, trainee surgeons are able to complete tasks quicker and with fewer errors than with 2D devices 6 . For complex procedures such as lymphadenectomies, separate studies have shown the 3D laparoscopes increased the confidence of novice surgeons 9 , and enabled experienced surgeons to perform more rapid and efficient procedures 7 .

3D laparoscopes not only reduce the overall OR time, but also make difficult tasks such as suturing and knotting easier and faster. In an interview with Prof. Antonio Lacy, Chief of GI surgery at Hospital Clinic Barcelona, Dr Lacy describes how ENDOEYE 3D enabled him to reduce the time needed to complete a complex surgical knot known as the ‘super knot’ from 60 to 37 seconds. The increased speed with which these tasks can be completed highlight the power of 3D laparoscopy to enhance surgeon expertise and patient outcomes.

Dr Antonio Alcaraz, chair of the Department of Urology at the Hospital Clinic in Barcelona, believes that learning laparoscopy is much easier in 3D and training with 3D vision can help drastically reduce the necessary learning time. In fact, he suggests that 50% of the improvement and shortening of the learning curve is as a result of the 3D vision.

Dr Antonio Alcaraz chair of the Department of Urology at the Hospital Clinic in Barcelona

With a heads-up display that enables the whole surgical team to view procedures in 3D, devices such as ENDOEYE 3D greatly improve procedural efficiency. This ability for easy visualization of procedures not only broadens the opportunity for hospital collaboration, but means that even inexperienced surgeons can gain vital first-hand experience of complex procedures.

Summary

For surgeons conducting regular laparoscopic procedures, the benefits of 3D devices are clear – enhanced imaging capability that reduces procedure times and lowers fatigue. Even for surgeons that are not ready to make the switch, devices such as ENDOEYE 3D also offer high-quality 2D imaging capability as standard – giving surgeons the option to experience both formats before making the choice.

The trend towards 3D laparoscopy shows no signs of stopping, with 3D procedures being adopted across a wide range of surgical disciplines, for a plethora of different surgical techniques. The enhanced imaging quality, faster procedure times and superior patient outcomes provided by 3D laparoscopes mean that more surgeons are switching to using these instruments every year.

References

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  2. 2.Impact of three-dimensional laparoscopy in a bariatric surgery program: influence in the learning curve. Padin, E.M., Santos, R.S., Fernández, S.G., Jimenez, A.B., Fernández, S.E., Dacosta, E.C., Duran, A.R., Rial, M.A. and Sanchez, I.D., 2017. Obesity surgery, 27(10), pp.2552-2556.
  3. 3.High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems. Kinoshita, H., Nakagawa, K., Usui, Y., Iwamura, M., Ito, A., Miyajima, A., Hoshi, A., Arai, Y., Baba, S. and Matsuda, T., 2015. Surgical endoscopy, 29(8), pp.2203-2209.
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  9. 9.How technology can impact surgeon performance: a randomized trial comparing 3-dimensional versus 2-dimensional laparoscopy in gynecology oncology. Fanfani, F., Rossitto, C., Restaino, S., Ercoli, A., Chiantera, V., Monterossi, G., Barbati, G. and Scambia, G., 2016. Journal of minimally invasive gynecology, 23(5), pp.810-817.
  10. 10.Perioperative, pathologic, and early continence outcomes comparing three-dimensional and two-dimensional display systems for laparoscopic radical prostatectomy—a retrospective, single-surgeon study. Aykan, S., Singhal, P., Nguyen, D.P., Yigit, A., Tuken, M., Yakut, E., Colakerol, A., Sulejman, S. and Semercioz, A., 2014. Journal of endourology, 28(5), pp.539-543.
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