3D laparoscopy: technique and initial experience in 451 cases

This study aims to show that 3D technology in laparoscopy promises to be an indispensable tool. The feasibility and safety of this surgical innovation has been shown. Our objective is to evaluate our initial experience performing 3D laparoscopic surgeries and determine if there is any benefit with respect to the time of surgery, time of morcellation, complications, and blood loss. Study design includes prospective analysis of 451 cases of 3D laparoscopy between September 2011 and August 2012 for total laparoscopic hysterectomy (TLH), laparoscopic myomectomy (LM), and other advanced surgeries. The setting of the study is in a tertiary endoscopic referral center. Between September 2011 and August 2012, 451 laparoscopic surgeries were performed using 3D HD camera and Einstein Vision telescope (Schoelly-Fibreoptic GMBH, Germany) (Fig. 1). An analysis was done showing various indications; the average time taken for surgery and morcellation (whenever indicated), the average blood loss, and the learning curve were determined. 3D TLH was done in 200 cases and was compared to the 200 cases in which 2D was used previously. The weights of specimens were comparable in both groups. The duration of surgery in 3D was less than 60 min in 132 cases, while only 110 cases with 2D took less than 60 min. This difference was statistically significant (p = 0.0316). Similarly, during laparoscopic myomectomy of 97 cases with 3D, 12 cases were done in less than 45 min, while only two cases were done in less than 45 min with the 2D system (p = 0.0101). This was statistically significant. The weights of specimens in both groups were comparable. The total blood loss during surgery with 2D and 3D was comparable and not statistically significant in both groups of TLH and LM. We had two conversions to conventional laparoscopy: one ureteric injury (patient with 2.1 kg uterus with anatomical distortion) and one relook after 12 h for hematoma evacuation. The largest uterus removed was 4.87 kg. 3D HD laparoscopy is a quantum leap in minimally invasive gynecology. The tactile feedback is retained; the precision, accuracy, and depth perception are remarkable. The learning curve is short (less than five cases). The initial investment and recurring cost are low compared to robotic-assisted laparoscopies. The time taken for surgery as well as morcellation is less than in 2D HD laparoscopy. The possibility of complications may be less also.