Comparison of laparoscopic nephrectomy results with three-dimensional and two-dimensional imaging systems

Öz

Objective: To evaluate the effects of three-dimensional (3D) and two-dimensional (2D) laparoscopic nephrectomies performed in a single center on intraoperative and early postoperative results.
Material and Methods: A total of 42 patients who were scheduled for laparoscopic nephrectomy in our clinic in 2019 and 2020 were included in the study. Transperitoneal laparoscopic simple/radical nephrectomy was performed in 21 patients (15 women, 6 men) with the 3D endovision system and in 21 patients (10 women, 11 men) with the 2D endovision system. Demographic characteristics of the patients (age, gender), operation time, the difference between preoperative and postoperative hemoglobin values, length of hospital stay, and complication rate were compared.
Results: Median age was 30 (9-74 years), mean operative time was 135.7 minutes, and the difference between preoperative hemoglobin value and postoperative hemoglobin value was calculated as 1.17 g/dl in 21 patients who used 2D. Radical nephrectomy was performed in 4 patients and simple nephrectomy in 17 patients. Clavien-Dindo grade 1 complication was seen in one patient.
The median age was 46 (16-73), the mean operative time was 128.6 minutes, and the difference between preoperative and postoperative hemoglobin values was 0.7 g/dl in 21 patients using 3D. Radical nephrectomy was performed in 10 patients and simple nephrectomy in 11 patients. No complications developed in the patients. In the comparison between the two groups, the difference between the preoperative hemoglobin value and the postoperative hemoglobin value was found to be significant (p: 0.041).
Conclusion: The depth perception provided by 3D endoscopic imaging systems allows for an easier understanding of anatomy and faster and easier dissection. With the ease of dissection, the amount of bleeding during the operation is reduced, bleeding areas are detected faster, and control can be achieved faster.

Anahtar Kelimeler

• three-dimensional
• two-dimensional
• laparoscopy
• nephrectomy

Üç boyutlu ve iki boyutlu görüntüleme sistemleri ile yapılan laparaskopik nefrektomi sonuçlarının karşılaştırılması

Öz

Amaç: Tek merkezde gerçekleştirdiğimiz laparaskopik nefrektomilerin üç boyutlu (3B) ve iki boyutlu (2B) sistemle uygulanmasının intraoperatif ve erken postoperatif sonuçlara etkisini değerlendirmek.
Gereç ve Yöntemler: Çalışmaya kliniğimizde 2019 ve 2020 yıllarında laparoskopik nefrektomi planlanan toplam 42 hasta dahil edildi. 3B endovizyon sistemi ile 21 hastaya (15 kadın, 6 erkek) 2B endovizyon sistemi ile 21 hastaya (10 kadın, 11 erkek) transperitoneal laparoskopik basit/radikal nefrektomi operasyonu yapıldı. Hastaların demografik özellikleri (yaş, cinsiyet), operasyon süresi, ameliyat öncesi hemoglobin değeri ile ameliyat sonrası hemoglobin değeri arasındaki fark, yatış süresi ve komplikasyon oranı karşılaştırıldı.
Bulgular: 2B kullanılan 21 hastada median yaş 30 (9-74), ortalama ameliyat süresi 135,7 dakika, ameliyat öncesi hemoglobin değeri ile ameliyat sonrası hemoglobin değeri arasındaki fark ortalama 1,17 gr/dl olarak hesaplandı. 4 hastaya radikal, 17 hastaya basit nefrektomi uygulandı. Bir hastada Clavien-Dindo derece 1 komplikasyon görüldü.
3B kullanılan 21 hastada median yaş 46 (16-73), ortalama ameliyat süresi 128,6 dakika, ameliyat öncesi hemoglobin değeri ile ameliyat sonrası hemoglobin değeri arasındaki fark 0,7 gr/dl olarak hesaplandı. 10 hastaya radikal, 11 hastaya basit nefrektomi uygulandı. Hastalarda komplikasyon gelişmedi. İki grup arası karşılaştırmada ameliyat öncesi hemoglobin değeri ile ameliyat sonrası hemoglobin değeri arasındaki fark anlamlı olarak bulundu (p: 0,041).
Sonuç: 3B endoskopik görüntüleme sistemlerinin sağlamış olduğu derinlik algısı anatominin daha kolay anlaşılmasına, diseksiyonun daha hızlı ve daha kolay yapılabilmesine olanak sağlamaktadır. Diseksiyon kolaylığı ile operasyon sırasındaki kanama miktarı azalmakta, kanama alanları daha hızlı saptanmakta ve kontrolü daha hızlı sağlanabilmektedir.

Anahtar Kelimeler

• iki boyutlu
• üç boyutlu
• laparoskopi
• nefrektomi

Kaynakça

1. Kavoussi LR, Novick AC, Partin AW et al. Campbell-Walsh Urology, 9th ed. Philadelphia: Saunders Elsevier, 2007.
2. Robson CJ, Churchill BM, and Anderson W. The Results of Radical Nephrectomy for Renal Cell Carcinoma J. Urol. 1969; 101:297–301.
3. Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF. Diagnosis and management of renal cell carcinomaA clinical and pathologic study of 309 cases. Cancer. 1971; 28:1165–77.
4. Clayman R V., Kavoussi LR, Soper NJ et al. Laparoscopic Nephrectomy: Initial Case Report. J Urol. 1991;146:278–82.
5. Shuford MD, McDougall EM, Chang SS, LaFleur BJ, Smith JA, Cookson MS. Complications of contemporary radical nephrectomy: comparison of open vs. laparoscopic approach. Urol Oncol Semin Orig Investig. 2004; 22:121–6.
6. Sakata S, Watson MO, Grove PM, Stevenson ARL. The Conflicting Evidence of Three-dimensional Displays in Laparoscopy. Ann Surg. 2016; 263:234–9.
7. Wenzl R, Pateisky N, Husslein P. Erstmaliger Einsatz eines 3D-Videoendoskopes in der Gynäkologie. Geburtshilfe Frauenheilkd. 1993; 53:776–8.
8. Buchs NC, Volonte F, Pugin F, Toso C, Morel P. Three-dimensional laparoscopy: a step toward advanced surgical navigation. Surg Endosc. 2013; 27:692–3.

9. Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo Classification of Surgical Complications. Ann Surg. 2009; 250:187–96.
10. van Bergen P, Kunert W, Bessell J, Buess GF. Comparative study of two-dimensional and three-dimensional vision systems for minimally invasive surgery. Surg Endosc. 1998; 12:948–54.
11. Hanna GB, Shimi SM, Cuschieri A. Randomised study of influence of two-dimensional versus three-dimensional imaging on performance of laparoscopic cholecystectomy. Lancet. 1998; 351:248–51.
12. Pietrabissa A, Scarcello E, Carobbi A, Mosca F. Three-dimensional versus two-dimensional video system for the trained endoscopic surgeon and the beginner. Endosc Surg Allied Technol. 1994; 2:315–7.
13. Yoshida T, Inoue H, Hara E et al. Newly Developed 3D Endoscopic System: Preliminary Experience. Endoscopy. 2003; 35:181–4.
14. Prudhomme T, Roumiguié M, Benoit T et al. Laparoscopy for living donor left nephrectomy: Comparison of three‐dimensional and two‐dimensional vision. Clin Transplant. 2019; 33:12.
15. Tokas T, Avgeris M, Leotsakos I, Nagele U, Gozen AS. Impact of three-dimensional vision in laparoscopic partial nephrectomy for renal tumors. Türk Üroloji Dergisi/Turkish J Urol. 2021; 47:144–50.
16. Patankar S, Padasalagi G. Three-dimensional versus two-dimensional laparoscopy in urology: A randomized study. Indian J Urol. 2017; 33:226.
17. Honeck P, Wendt-Nordahl G, Rassweiler J, Knoll T. Three-Dimensional Laparoscopic Imaging Improves Surgical Performance on Standardized Ex-Vivo Laparoscopic Tasks. J Endourol. 2012; 26:1085–8.
18. Cicione A, Autorino R, Breda A et al. Three-dimensional vs Standard Laparoscopy: Comparative Assessment Using a Validated Program for Laparoscopic Urologic Skills. Urology. 2013; 82:1444–50.
19. Romero-Loera S, Cárdenas-Lailson LE, de la Concha-Bermejillo F, Crisanto-Campos BA, Valenzuela-Salazar C, Moreno-Portillo M. Skills comparison using a 2D vs. 3D laparoscopic simulator. Cirugía y Cir English Ed. 2016; 84:37–44.
20. Park YS, Oo AM, Son S-Y et al. Is a robotic system really better than the three-dimensional laparoscopic system in terms of suturing performance?: comparison among operators with different levels of experience. Surg Endosc. 2016; 30:1485–90.