Three-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia rep
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and Other Interventional Techniques
Three‑dimensional versus two‑dimensional high‑definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study Hanna E. Koppatz1 · Jukka I. Harju1 · Jukka E. Sirén1 · Panu J. Mentula1 · Tom M. Scheinin1 · Ville J. Sallinen1,2 Received: 14 July 2019 / Accepted: 12 November 2019 © The Author(s) 2019
Abstract Background Three-dimensional (3D) laparoscopy improves technical efficacy in laboratory environment, but evidence for clinical benefit is lacking. The aim of this study was to determine whether the 3D laparoscopy is beneficial in transabdominal preperitoneal laparoscopic inguinal hernia repair (TAPP). Method In this prospective, single-blinded, single-center, superior randomized trial, patients scheduled for TAPP were randomly allocated to either 3D or two-dimensional (2D) TAPP laparoscopic approaches. Patients were excluded if secondary operation was planned, the risk of conversion was high, or the surgeon had less than five previous 3D laparoscopic procedures. Patients were operated on by 13 residents and 3 attendings. The primary endpoint was operation time. The study was registered in ClinicalTrials.gov (NCT02367573). Results Total 278 patients were randomized between 5th February 2015 and 23rd October 2017. Median operation time was shorter in the 3D group (56.0 min vs. 68.0 min, p 50 3D laparoscopic procedures, surgeons with any experience in TAPP, patients with body mass indices 50 previous cases for TAPP; 10, or > 50 previous cases for 3D laparoscopic procedures in general). The subjective satisfaction of each surgeon was collected based on a 0–10 Likert scale score, and the surgeons were free to express comments or concerns regarding the laparoscope in free text form after the operation. The stereo acuity was measured using the Randot® Stereotest (Stereo Optical, Chicago, Illinois, USA), but surgeons were neither selected nor excluded based on the test. The Randot test consists of ten sets of three circles, one of which has a crossed disparity and appears to be closer. Between the sets, the disparity decreases from 400 to 20 s of arc. If the surgeon could not distinguish the differences between the sets, he/she was considered stereo blind (0 points). Otherwise, the level of stereopsis was defined as the last circle identified correctly. The level of perfect stereopsis was defined to 20 s of arc (10 points). The operation time was defined as the time from the first incision until closure of the skin. First 12 mm trocars were inserted umbilically and in the left or right lower abdomen, depending on side of the hernia. One 5 mm trocar was inserted in side opposite of the hernia. In cases of bilateral hernias, a 12 mm trocar was used in place of the 5 mm trocar. The peritoneum was opened cranial to the hernia site. Peritoneum was
This was a randomized controlled trial conducted in the day surgery department of an academic teaching hospital (Helsinki University Hospital) which functions as a secondary referr
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