Subjective perception of surgeons with three-dimensional and two-dimensional systems in laparoscopic colorectal surgery: a randomized controlled trial

Objective To compare the subjective perception of surgeons with three-dimensional (3D) and two-dimensional (2D) systems in the laparoscopic colorectal surgery. Methods The prospective study was adopted. The subjective questionnaires from surgeons including major surgeons, first assistants and camera assistants who performed laparoscopic colorectal surgeries with 3D and 2D systems and were required to finish the questionaires within 2 hours after surgery at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine between November 2013 and June 2015 were collected. The surgeons who performed laparoscopic colorectal surgery with 3D laparoscope and 4-directional camera were allocated into the 3D laparoscopic group and surgeons who performed laparoscopic colorectal surgery with 2D laparoscope and 30° convertible camera were allocated into the 2D laparoscopic group. The questionnaire included visual difference of continuous motion, binocular focusing difference, 2D or 3D pixel stability, control coordination of visual angle, freedom of view angle, inactive area of 3D, imaging capacity, light control capacity, frame rate, radiance, resolution ratio, depth description and colour resolution. Observation indicators included: (1) overall comparison of the subjective scores for laparoscope between surgeons of 3D and 2D laparoscopic groups. (2) Respective comparison of the subjective scores for laparoscope between major surgoens, first assistants, camera assistants of 3D and 2D laparoscopic groups. Measurement data with normal distribution were presented as ±s, and comparison was done by the t test. Results All the 85 questionnaires were screened for eligibility, including 53 in the 3D laparoscopic group (16 from major surgoens, 21 from first assistants, 16 from camera assistants) and 32 in the 2D laparoscopic group (10 from major surgoens, 12 from first assistants, 10 from camera assistants). (1) Overall comparison of the subjective scores for laparoscope between surgeons of 3D and 2D laparoscopic groups: the scores of surgeons for ophthalmic fatigue degree, ophthalmic vertigo degree, control coordination degree of visual angle and depth description were 4.3±0.8, 4.5±0.7, 4.2±0.8, 4.4±0.7 in the 3D laparoscopic group and 4.6±0.5, 4.9±0.7, 4.7±0.6, 3.9±0.8 in the 2D laparoscopic group, respectively, with statistically significant differences (t=1.899, 3.493, 2.458, -2.872, P<0.05). (2) Comparison of the subjective scores for laparoscope between major surgeons of 3D and 2D laparoscopic groups: the scores of major surgeons for ophthalmic vertigo degree, control coordination degree of visual angle and colour resolution were 4.4±0.7, 3.9±0.8, 4.6±0.6 in the 3D laparoscopic group and 5.0±0.0, 4.6±0.7, 5.0±0.0 in the 2D laparoscopic group, respectively, with statistically significant differences (t=2.426, 2.423, 1.901, P<0.05). (3) Comparison of the subjective scores for laparoscope between first assistants of 3D and 2D laparoscopic groups: the scores of first assistants for ophthalmic vertigo degree, topographical orientation and depth description were 4.4±0.7, 4.7±0.6, 4.4±0.7 in the 3D laparoscopic group and 4.8±0.4, 4.1±0.4, 3.8±1.1 in the 2D laparoscopic group, respectively, with statistically significant differences (t=1.740, -2.062, -1.868, P<0.05). (4) Comparison of the subjective scores for laparoscope between camera assistants of 3D and 2D laparoscopic groups: the scores of camera assistants for ophthalmic vertigo degree and control coordination degree of visual angle were 4.6±0.6, 4.4±0.7 in the 3D laparoscopic group and 5.0±0.0, 4.9±0.3 in the 2D laparoscopic group, respectively, with statistically significant differences (t=1.901, 1.891, P<0.05). Conclusions 3D laparoscopic system is similar to the traditonal 2D laparoscopic system in surgical procedures of laparoscopic colorectal surgery. Compared with 2D laparoscopic system, 3D laparoscopic system is not good enough in the ophthalmic fatigue degree and the degree of ophthalmic vertigo, however, it can provide good three-dimensional vision, strengthen stereoscopic vision and depth, help identify anatomical structure and level. Key words: Colorectal neoplasms; Surgical procedures, operative; Laparoscopy; Three-dimensional technique; Two-dimensional technique