Pirmin Storz

For 3D laparoscopy: a step toward advanced surgical navigation: how to get maximum benefit from 3D vision

The authors are grateful for the interesting perspectives given by Buchs and colleagues in their letter to the editor entitled “3D Laparoscopy: A Step Toward Advanced Surgical Navigation.” Shutter-based 3D video systems failed to become established in the operating room in the late 1990s. To strengthen the starting conditions of the new 3D technology using better monitors and high definition, the authors give suggestions for its practical use in the clinical routine. But first they list the characteristics of single-channeled and bichanneled 3D laparoscopes and describe stereoscopic terms such as “comfort zone,” “stereoscopic window,” and “near-point distance.” The authors believe it would be helpful to have the 3D pioneers assemble and share their experiences with these suggestions. Although this letter discusses “laparoscopy,” it would also be interesting to collect experiences from other surgical disciplines, especially when one is considering whether to opt for bi- or single-channeled optics.

[3D in laparoscopy: state of the art].

ZusammenfassungDie stereoskopische Sicht (das beidäugige 3-D-Sehen) wurde in hoher Auflösung (HD) in den Operationssaal eingeführt. Diese Übersichtsarbeit zeigt die optischen und physiologischen Grundlagen sowie den Stand der Technik für den Einsatz von 3-D in der Laparoskopie auf. Es werden die Merkmale von 3-D-Endoskopen und -Monitoren aufgeführt und Besonderheiten der Stereoskopie, wie Komfortzonen und Ghosting, erläutert. Empfehlungen für den praktischen Einsatz in der Klinikroutine sollen dabei helfen, optimalen Nutzen aus der neuen Technik zu ziehen.AbstractHigh definition stereoscopic (3D) vision has been introduced into the operation theatre. This review exposes the optical and physiological background as well as the state of the art of 3D in laparoscopy. The distinguishing marks of 3D laparoscopes and monitors are listed and characteristics of stereoscopy, such as comfort zones and ghosting are explained. Suggestions for the practical use in the clinical routine should help to extract the best benefit possible from the new technology.High definition stereoscopic (3D) vision has been introduced into the operation theatre. This review exposes the optical and physiological background as well as the state of the art of 3D in laparoscopy. The distinguishing marks of 3D laparoscopes and monitors are listed and characteristics of stereoscopy, such as comfort zones and ghosting are explained. Suggestions for the practical use in the clinical routine should help to extract the best benefit possible from the new technology.

3-D in der Laparoskopie

ZusammenfassungDie stereoskopische Sicht (das beidäugige 3-D-Sehen) wurde in hoher Auflösung (HD) in den Operationssaal eingeführt. Diese Übersichtsarbeit zeigt die optischen und physiologischen Grundlagen sowie den Stand der Technik für den Einsatz von 3-D in der Laparoskopie auf. Es werden die Merkmale von 3-D-Endoskopen und -Monitoren aufgeführt und Besonderheiten der Stereoskopie, wie Komfortzonen und Ghosting, erläutert. Empfehlungen für den praktischen Einsatz in der Klinikroutine sollen dabei helfen, optimalen Nutzen aus der neuen Technik zu ziehen.AbstractHigh definition stereoscopic (3D) vision has been introduced into the operation theatre. This review exposes the optical and physiological background as well as the state of the art of 3D in laparoscopy. The distinguishing marks of 3D laparoscopes and monitors are listed and characteristics of stereoscopy, such as comfort zones and ghosting are explained. Suggestions for the practical use in the clinical routine should help to extract the best benefit possible from the new technology.High definition stereoscopic (3D) vision has been introduced into the operation theatre. This review exposes the optical and physiological background as well as the state of the art of 3D in laparoscopy. The distinguishing marks of 3D laparoscopes and monitors are listed and characteristics of stereoscopy, such as comfort zones and ghosting are explained. Suggestions for the practical use in the clinical routine should help to extract the best benefit possible from the new technology.

Utility of Routine Ultrasound after Laparoscopic Cholecystectomy to Detect Early Postoperative Complication

Background and Aim: In up to 3% of laparoscopic cholecystectomies, procedure-related complications occur. Routine postoperative ultrasound is one means of screening for these complications. The aim of this study was to determine the utility of this practice after laparoscopic cholecystectomy. Methods: A series of consecutive patients (n = 1,044) undergoing laparoscopic cholecystectomy from January 2007 to January 2011 was analysed. Primary endpoint was the detection of procedure-related complications by routine ultrasound. Results: Routine ultrasound within the first 48 h after laparoscopic cholecystectomy was performed in 967 of 1,044 patients. Overall, 25 (2.4%) of the 1,044 patients suffered from procedure-related complications, but only in 2 patients was the complication detected by routine ultrasound. Findings were false-positive in 103 patients. This corresponds to a sensitivity of 8% and a specificity of 89%. Hospital stay was prolonged in the false-positive group. Conclusion: Routine postoperative ultrasound has a low sensitivity for the detection of complications after laparoscopic cholecystectomy. In almost all cases, the diagnosis is initiated by clinical findings. Therefore, routine ultrasound is of limited value in screening for postoperative complications after cholecystectomy.

How Much Stereoscopic Effect Does Laparoscopy Need? Controlled, Prospective Randomized Trial on Surgical Task Efficiency in Standardized Phantom Tasks

Background. To regain 2-eyed vision in laparoscopy, dual-channeled optics have been introduced. With this optics design, the distance between the 2 front lenses defines how much stereoscopic effect is seen. This study quantifies the impact of an enhanced and a reduced stereo effect on surgical task efficiency. Methods. A prospective single-blinded study was performed with 20 laparoscopic novices in an inanimate experimental setting. A standard bichannelled stereo system was used to perform a suturing and knotting task. The working distance and the task size were scaled to vary the stereo effect and, thereby, simulate hypothetic stereo optics with enhanced and reduced optical bases. The task performances were timed, and the number of trials for stitching out was counted. The participants finally filled out a questionnaire to collect subjective impressions. Results. The increase of the stereo effect by 50% caused no objective improvement in laparoscopic knotting compared with typical 3D (control group with stereo basis of 4.5 mm). But ergonomic disadvantages (headache) were subjectively reported in 1 of 20 cases in the questionnaire. The reduction of the stereo effect by one-third led to a significantly longer average execution time. There was no significant dependence found between stereo effect and number of stich-out trials, stitching precision, or knotting quality. Conclusions. Considering laparoscopy, it does not seem advisable to enhance the stereo effect because of ergonomic problems. Otherwise, a miniaturization of the 3D scope (5 mm version) is problematic because its benefit mostly shrinks with the reduced stereo effect.

3-D in der Laparoskopie@@@3D in laparoscopy: Stand der Technik@@@State of the art

ZusammenfassungDie stereoskopische Sicht (das beidäugige 3-D-Sehen) wurde in hoher Auflösung (HD) in den Operationssaal eingeführt. Diese Übersichtsarbeit zeigt die optischen und physiologischen Grundlagen sowie den Stand der Technik für den Einsatz von 3-D in der Laparoskopie auf. Es werden die Merkmale von 3-D-Endoskopen und -Monitoren aufgeführt und Besonderheiten der Stereoskopie, wie Komfortzonen und Ghosting, erläutert. Empfehlungen für den praktischen Einsatz in der Klinikroutine sollen dabei helfen, optimalen Nutzen aus der neuen Technik zu ziehen.AbstractHigh definition stereoscopic (3D) vision has been introduced into the operation theatre. This review exposes the optical and physiological background as well as the state of the art of 3D in laparoscopy. The distinguishing marks of 3D laparoscopes and monitors are listed and characteristics of stereoscopy, such as comfort zones and ghosting are explained. Suggestions for the practical use in the clinical routine should help to extract the best benefit possible from the new technology.High definition stereoscopic (3D) vision has been introduced into the operation theatre. This review exposes the optical and physiological background as well as the state of the art of 3D in laparoscopy. The distinguishing marks of 3D laparoscopes and monitors are listed and characteristics of stereoscopy, such as comfort zones and ghosting are explained. Suggestions for the practical use in the clinical routine should help to extract the best benefit possible from the new technology.