Three-dimensional Stereoscopic Vision System Laparoscopy Using Monitors in Gastroenterological, Thoracic, Urologic and Gynecological Conditions

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; GLUJOVSKY, D.; ALCARAZ, A.; LOPEZ, A; BARDACH, A.; CIAPPONI, A

Documento de Evaluación de Tecnologías Sanitarias

IECS

Año: 2013 p. 1 - 30

1668-2793

Laparoscopic surgery consists in performing small incisions in the abdomen or chest assisted by a video camera used to visualize the surgical field and perform the intervention. The operating room equipment includes monitors where the images produced by the video camera can be seen. An important issue when performing a minimally invasive procedure is the correct visualization of the surgical field. Endoscopic surgeons depend on the visual feedback to control their movements. Technology Several stereoscopic laparoscopic visual systems have been developed to improve the surgical skills through depth perception. There are several types of stereoscopic vision systems: monitors showing stereoscopic images which are observed through glasses with filters, displays mounted on the head with independent images for each eye, and robotic-assisted surgical systems. It has been proposed that using three-dimensional images with a monitor in laparoscopic surgery for several indications such as gastroenterology, chest, urology and gynecology will pose an increased benefit and less surgical stress for the surgeon. The three-dimensional robotic surgery and the devices mounted for stereoscopic vision on the surgeon?s head were not considered in the present report. Purpose The purpose of this report is to assess the available evidence on the efficacy, coverage policies and safety aspects related to laparoscopic surgery with 3D monitors for gastroenterological, thoracic, urologic and gynecological conditions. Methods A bibliographic search was carried out on the main bibliographic databases (MEDLINE, Cochrane, DARE, NHS EED), in general Internet search engines, in sanitary technology evaluation agencies and health suppliers, using the following key words: ?laparoscopy? and ?SEV? or ?threedimensional? and its abbreviations in plain text and MeSH descriptors. Priority was given to systematic reviews, meta-analysis, randomized controlled clinical trials, clinical practice guidelines, health technology assessments, financial assessments, and coverage policies.. Results One systematic review from the Cochrane Collaboration was identified, which included an RCT, another additional RCT not included in the SR, and observational studies, one in real patients and several in training sessions. One systematic review published in 2011 compared the benefits and risks of using threedimensional images versus traditional images for laparoscopic cholecystectomy. It identified a single RCT conducted in 1997 where 60 surgeries were randomly assigned to one of the image monitors, two-dimensional or three-dimensional (30 per method). The surgeries were performed by four specialists as part of their advanced surgical training. The principal assessment criteria were surgical time and mistakes made during the procedure. The secondary endpoints were subjective assessment of image quality and adverse effects on the surgeon. There were no differences between the Standard Endoscopic Vision (SEV) and three- dimensional Stereoscopic Visualization (SV) in mean execution time (average difference = -1.00 minute; 95% CI -17.7 to 15.7, p =0.2) or the surgeon?s mistakes rate. The study had moderate methodological quality, mainly due to lack of blinding. Additionally, a second RCT published in 2007 comparing a new computer system with a standard vision monitor during gynecological laparoscopic surgery was identified. The VS-1 system was analyzed in terms of surgical results and surgical satisfaction. Eighty eight patients who underwent laparoscopic surgery of different levels of difficulty and performed by three different surgeons, ranging from novel to experienced, were randomly assigned to the computer VS-1 vision imaging system or the conventional system with endoscopic vision; 44 patients to each group. Controlling by variables such as surgeon?s experience and level of surgery difficulty in a multilevel analysis, the length difference in minutes for short surgeries reached clinical significance (39 vs. 36 minutes p