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Y. Kaufman, A. Sharon, O. Klein, D Spiegel, R. Oslander and A. Lissak

The 3-Dimensional “ Insect Eye ” Laparoscopic Imaging System - Evaluation of a Novel Technology by a Prospective Randomized Study. Y. Kaufman, A. Sharon, O. Klein, D Spiegel, R. Oslander and A. Lissak The Lady Davis Carmel Medical Center, Haifa, Israel.

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Y. Kaufman, A. Sharon, O. Klein, D Spiegel, R. Oslander and A. Lissak

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  1. The 3-Dimensional “Insect Eye” Laparoscopic Imaging System - Evaluation of a Novel Technology by a Prospective Randomized Study Y. Kaufman, A. Sharon, O. Klein, D Spiegel, R. Oslander and A. Lissak The Lady Davis Carmel Medical Center, Haifa, Israel

  2. Minimally Invasive Surgery (MIS) – Time to improve 1. Safety 2. Cost 3. Operative durations 4. Learning curve 5. Future applications ?!

  3. Handicaps of laparoscopic surgery • No direct visualization • Loss of haptic (active touch) perception • Movements of instruments is restricted – based on a fixed pivot point on the abdominal wall • Information for performing 3-D movements is received on a 2-D monitor

  4. Depth perception MONOCULAR CUES

  5. Depth illusion

  6. Depth illusion

  7. Error types: • Perceptual input data (visual/haptic): • Surgeon had deliberately cut a duct thought to be a different duct • Surgeon injured an unseen duct • Knowledge & decision making: • Unorthodox strategy of surgery • Performed an operation in an inappropriate setting • Action (technical skill) Way LW, Stewart L, Gantert W. et al. Causes and Prevention of Laparoscopic Bile Duct Injuries. Annals of Surgery, 2003 27(4) 460-9

  8. 97% Way LW, Stewart L, Gantert W. et al. Causes and Prevention of Laparoscopic Bile Duct Injuries. Annals of Surgery, 2003 27(4) 460-9

  9. “Z lag” • Aligning X and Y axes before moving in the depth Z axis

  10. Monocular cues • Optical illusions → Erroneous movements → Accidents • Decreased accuracy of movements → More ballistic correctional sub-movements → Longer operations • “Z lag” - Aligning on the X and Y axes before moving in the depth Z axis → Longer operations & smeared learning curves

  11. 3D Laparoscopic Imaging Systems • Reduce: • Number of movements • Total distance of movements • Surgery duration 40-50% Taffinder N, Smith SG, Huber J, et al. The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons. Surgical Endoscopy, 1999. 13(11): 1087-92

  12. Second generation imaging systems Images are different not only in angle but in color, optical distortion and sharpness Fatigue, headache, nausea, dizziness, eye strain

  13. “Insect eye” technology • Single video chip with 100,000s tiny ‘eyes’ (pixels) embedded in 3x3 mm chip Many small, slightly distorted images image processing computer Images divided into “left” & “right” according to a specialized algorithm

  14. Research with the “Insect eye” technology • University of Bologna, Italy • Lahey Clinic, Boston, USA • Sheba Medical Center, Israel • Ichilov Medical Center, Israel • Carmel Medical Center, Israel

  15. Benefits using the “Insect eye” technology • Reduction in operative time for experienced as well as novice surgeons • Shorter learning curve • Greater satisfaction reported by the surgeon • No side effects

  16. Table 1: Surgery duration in minutes according to the type of operation and the type of imaging system used

  17. Figure 1: Surgery duration in minutes according to the experience of the surgeon and the type of imaging system used. (n = number of subjects in each group)

  18. Figure 2: Amount of blood loss (in cc) according to the level of difficulty as estimated by the surgeon and to the type of imaging system used. (n = number of subjects in each group)

  19. Figure 3: surgeon satisfaction criteria using the 2-D vs. 3-D imaging systems (1=Insufficient, 2=Sufficient, 3=Excellent)

  20. Benefits using the “Insect eye” technology • Reduction in operative time for experienced as well as novice surgeons • Shorter learning curve • Greater satisfaction reported by the surgeon • No side effects • Decreased operative durations found mostly in shorter operative procedures

  21. More possible benefits • Advanced performance surgery – lymph node dissection • Narrow operative fields • Integration with other imaging modalities • CT image reconstruction • Intra-abdominal 3D + 4D US • “See through the tissue”

  22. Thank you The 3-Dimensional “Insect Eye” Laparoscopic Imaging System - Evaluation of a Novel Technology by a Prospective Randomized Study Y. Kaufman M.D¹., A. Sharon M.D. ¹., O. Klein M.D. ¹., D Spiegel M.D.², R. Auslander, M.D. ¹. and A. Lissak M.D. ¹.

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