1. 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

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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. 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 2D10 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

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

15. 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

16. 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)

17. 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.

18. Limitation
small sample size
selection bias

19. 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