A comparison between 3D & conventional laparoscopic colectomy 楊逸文1, 姜正愷1,2, 林楨國1,2, 林資琛1,2, 楊純豪1,2, 陳維熊1,2 ,張世慶1,2, 王煥昇1,2, 林春吉1,2, 林宏鑫1,2, 黃聖捷1,2 台北榮總大腸直腸外科1 國立陽明大學2

Background lack of depth perception with conventional 2D laparoscopy The benefit of 3D system in colectomy surgery ?

Method from Jan.2016 to Dec.2017. 230 patients who received laparoscopic colectomy Indication: colorectal tumor single surgeon team Exclusion criteria: combine metastasectomy, subtotal colectomy prospectively constructed database nonvalidated subjective questionnaire

Journal of Display Technology, vol. 1,no. 2, pp. 328-340, Dec 2005.

Result- demography 3D (N=119) 2D (N=111) p Age (year) 64 63.46 0.7735 SEX 0.2502 male 69 55 female 50 56 BMI 23.7 23.52 0.6948 DM 20 14 0.4779 tumor side 0.6932 right 36 30 left 83 81

pathology 3D (N=119) 2D(N=111) p 0.4353 Adenocarcinoma 91 84 Mucinous adenocarcinoma 5 3 No residual tumor 11 9 Tubular adenoma 4 2 Tubular adenoma with adenocarcinoma Tubular adenoma with high grade dysplasia Adenocarcinoma with neuroendocrine differentiation 1 Tubulovillous adenoma Tubulovillous adenoma with adenocarcinoma Tubulovillous adenoma with focal high grade dysplasia Diffuse large B cell lymphoma Leiomyosarcoma Chronic granulomatous inflammation with caseous necrosis Neuroendocrine tumor, grade 1

3D (N=119) 2D (N=111) p Pathologic stage 0.5528 I 26 18 II 33 27 III 40 43 IV 9 14 not CRC or no residual tumor 11 operation 0.3663 Laparoscopic abdomino-perineal resection 3 2 Laparoscopic anterior resection 44 34 Laparoscopic left hemicolectomy 6 12 Laparoscopic low anterior resection 16 19 Laparoscopic right hemicolectomy 36 32 TaTME handsewn 0.1355

Post-op hospital stay (days) (N=119) 2D (N=111) p op time (mins) 248.4 260.9 0.2642 Post-op hospital stay (days) 9.9 9.2 0.2039 blood loss (ml) 43 50 0.4483 complication 7 1 0.085 N numbers 19.7 20.12 0.7307 Operative outcome

Complications 3D 2D p Chyle leak 5 (4%) 0.08 anastomosis leakage 0.08 anastomosis leakage 2 (1.7%) 0.5 anastomosis stenosis 1(1%) 0.93

Post-op hospital stay (days) BMI>29 3D (N=7) 2D (N=9) p op time (mins) 238.9 343.9 0.02697 Post-op hospital stay (days) 7.29 10.8 0.00929 blood loss (ml) 35.7 102.2 0.2261 N number 24.6 19.1 0.1377 14.47461 195.58888 1.020849 5.963278

Operator/1st assistant/2nd assistant QUESTIONNAIRE N=29 VS/Fellow/Resident 11/ 6/12 Operator/1st assistant/2nd assistant 15/ 9/ 5 2D surgery experience >60/30-60/<30 14/ 6/ 9 3D surgery experience 5/10/14

視覺疲勞問卷 疲勞 乾澀 畏光 眼皮跳 眼壓 眼窩痛 灼熱 頭痛 沉重 頭暈 肩硬 注意力 total 2D 1.55 1.21 1.17 1.14 1.03 1.07 1.1 1.45 14.1 3D 1.86 1.38 1.31 0.1 1.24 1.28 15.1 p 0.081 0.2474 0.3046 1 0.3094 0.647 0.51 0.2628 0.2468 0.6015 0.7522 0.236

手術體驗問卷 舒 適 視野準確 器械準確 視野快速 器械快速 定位血管 結扎血管 取淋巴結 縫合 打結 自動縫合 視覺呈現 手術技巧 2D 10 2 3 1 3D 12 21 27 15 20 23 19 24 28 26 17 25 same 7 6 11 5 4 p 0.52 < 0.05

Discussion Performance time Not to influence the performance time Surg Laparosc Endosc Percutan Tech. 2016 Aug;26(4):324-7. Not to influence the performance time Laparoendoscopic & Advanced Surgical Techniques. March 2016, 26(3): 213- 217

Complication- leakage Case 1: 67M s/p LAR, tumor at AV 10cm; Anastomosis: CDH; POD6 soft diet with stool+, fever on POD7 Case 2: 76M s/p AR, a small defect at anastomosis (AV 10cm) s/p 2 clips

Complication- chyle leakage Case 1: 73F s/p RH, hx of appendectomy with severe adhesion between omentum and abdominal wall; HCC s/p TAE; LN 203(1)\223(1) Case 2: 88M s/p AR, 7x5 cm at sigmoid colon and 5x4 cm tumor at middle desending colon, LN 253(2/2), 40 LN removed Case 3: 68F s/p AR, LN 253(4), CT presence of enlarged lymph nodes at Lt paraaortic retroperitoneal region and SMA root Case 4: 38M, s/p AR, BMI 30, 36 LN removed, 253(6), no energy device Case 5: 43F, s/p AR, clinical stage N2, 253(2)

Conclusion There was no significant difference in our operative outcomes. More complication in 3D Surgeons prefer 3D laparoscopy Visual fatigue should be an issue of 3D. In subgroup of BMI >29, the operative time and post-op hospital stay were shorter in 3D laparoscopic surgery group.

Limitation small sample size selection bias

Thank you Acknowledgement: 台北慈濟、中 國醫大、林口長庚、北醫、和信、高 雄長庚的醫師參與問卷填寫。 Q & A