Surgical outcomes of total laparoscopic hysterectomy with 2-dimensional versus 3-dimensional laparoscopic surgical systems

Abstract

Three-dimensional (3D) laparoscopic surgical systems have been developed to account for the lack of depth perception, a known disadvantage of conventional 2-dimensional (2D) laparoscopy. In this study, we retrospectively compared the outcomes of total laparoscopic hysterectomy (TLH) with 3D versus conventional 2D laparoscopy. From November 2014, when we began using a 3D laparoscopic system at our hospital, to December 2015, 47 TLH procedures were performed using a 3D laparoscopic system (3D-TLH). The outcomes of 3D-TLH were compared with the outcomes of TLH using the conventional 2D laparoscopic system (2D-TLH) performed just before the introduction of the 3D system. The 3D-TLH group had a statistically significantly shorter mean operative time than the 2D-TLH group (119±20 vs. 137±20 min), whereas the mean weight of the resected uterus and mean intraoperative blood loss were not statistically different. When we compared the outcomes for 20 cases in each group, using the same energy sealing device in a short period of time, only mean operative time was statistically different between the 3D-TLH and 2D-TLH groups (113±19 vs. 133±21 min). During the observation period, there was one occurrence of postoperative peritonitis in the 2D-TLH group and one occurrence of vaginal cuff dehiscence in each group, which was not statistically different. The surgeon and assistant surgeons did not report any symptoms attributable to the 3D imaging system such as dizziness, eyestrain, nausea, and headache. Therefore, we conclude that the 3D laparoscopic system could be used safely and efficiently for TLH.

Keywords: 3-dimensional laparoscopy; surgical outcomes; total laparoscopic hysterectomy.

Fig. 1.

Total laparoscopic hysterectomy (TLH) procedure for this study. The vesicouterine peritoneal fold was opened and bladder was mobilized inferiorly with a blunt dissection (1A). The upper uterine ligaments were dissected using LigaSure V^® or Thunderbeat^® energy sealing device (1B). The ureters and uterine arteries were identified in retroperitoneal space, and the uterine arteries were ligated and cut (1C). The cardinal ligaments were ligated and dissected using an energy sealing device (1D). The uterovaginal canal was incised by monopolar electrosurgical knife while the dissection line was clarified using VAGI Pipe^® inserted into the vagina (1E). The uterus was cut down and extracted transvaginally (1F). The vaginal cuff was closed with laparoscopic one-layer Z-plasty suturing with 0-Vicryl (1G). Finally, the retroperitoneum was closed with continuous using 2-0 Vicryl sutures (1H).

Fig. 2.

Learning curve based on operative time for 135 cases of total laparoscopic hysterectomy (TLH) performed by one surgeon until December 2015. The slope of the learning curve decreased after approximately 30 cases. The surgeon was considered to proficient at TLH before the beginning of this study.

Fig. 3.

Operation time for each case and the three comparison groups in this study. ① The red rectangle indicates the comparison between 47 cases of two-dimensional total laparoscopic hysterectomy(2D-TLH) and 47 cases of three-dimensional (3D)-TLH. ② The blue rectangle indicates the comparison between 20 cases of 2D-TLH and 20 cases of 3D-TLH. ③ The green rectangle indicates the comparison between the first 23 cases and subsequent 22 cases of 3D-TLH.