Three-Dimensional Minimally Invasive Surgery Enhances Surgeon’s Performances, Reducing Operative Time and Errors. Comparative Study in a Pediatric Surgery Setting.

Assumptions Advanced MIS procedures in neonates & infants <5 kg are a very demanding field because of: • very small anatomical structures • limited operative spaces (5-7 cm3) Postulate 3D laparoscopy improves operative time & precision in small spaces Advantages in 3D laparoscopy are mostly described in adults for better depth perception, more precise visualization of anatomical structures, as well as for complex manoeuvres such as suturing. In the pediatric field these data are lacking. In collaboration with Neuromed (Neuromed Spa, Torino) and Storz (Karl Storz, Tuttlingen, Germany) we tested 3D 4mm scopes specific for pediatric laparoscopy with a 3D HD camera, with the possibility to shift from 3D to 2D. In vitro setting – 1 With Visionsense III Stereoscopic Endoscopy System (Neuromed Spa), FDA and CE approved for pediatric surgery, we performed a comparative study between surgical skills achievements in subjects without any surgical experience, using 2D and a 3D laparoscopic equipment. 3 skills were evaluated in 2D and 3D modalities. 20 pediatrics residents without any previous laparoscopic experience were randomly divided in two groups and evaluated doing object transfer and basic surgical manoeuvres in a laparoscopic simulator validated for pediatric surgery. Switching the type of vision from 2D to 3D we evaluated bimanual dexterity, efficiency, tissue handling in both modalities. Time and error rates (missed attempts, dropped objects, and failure to complete the task) were recorded. In vitro setting – 2 Experimental project comparing 2D vs 3D laparoscopic camera in a set-up standardized and validated for Pediatric Surgeons. With Storz TipCam 4mm, we performed a comparative study between surgical skills achievements in experienced pediatric surgeons. Four skills were evaluated in 2D and 3D modalities. 10 pediatric surgeons with more than 50 MIS procedures were randomly divided in two groups and evaluated doing 3 training modules (“threading”, “suturing”, “tension suturing” and “intestinal anastomosis”) in a laparoscopic simulator (iSIM2 – iSurgicals, Chorley, UK). Switching the type of vision from 2D to 3D we evaluated bimanual dexterity, efficiency, tissue handling in both modalities. Time and error rates (missed attempts and failure to complete the task) were recorded. Inconveniences related to the 3D vision were also recorded. Surgical Application Using Visionsense III Stereoscopic Endoscopy System and Storz TipCam 4mm we performed 40 laparoscopic/thoracoscopic procedures in children and neonates hospitalized at the Regina Margherita Children’s Hospital. Operative time and intra- or post-operative complications were recorded.