A Comparison Of 3-D Versus Conventional 2-D Laparoscopic Radical Prostatectomy

[Objective]Prostate cancer is one of the common urologic malignancies in clinical practice. Conventional 2-Dimensional (2-D) laparoscopic technique has been widely used in radical prostatectomy. As the rapid development and increasing application of 3-Dimentional (3-D) technique and its multiple superiorities, more and more radical prostatectomy surgeries are assisted by 3-D laparoscopy. We compared the clinical data between the 3-D and conventional 2-D laparoscopic radical prostatectomy to evaluate the value and safety of clinical application of 3-D laparoscopic radical prostatectomy.[Methods]Retrospective review of the clinical data of 45 cases who underwent laparoscopic radical prostatectomy due to prostate cancer in the Department of Urology in Qilu Hospital between January,2015 and January,2016 was conducted. They included 20 cases of 3-D and 25 cases of 2-D laparoscopic surgeries. The diagnosis of prostate cancer was confirmed preliminarily by the pathology of transrectal ultrasound guided prostate biopsy in all the cases. By collecting and sorting relative data, we have contrasted and analyzed the patients’ general demographic information (age, weight and preoperative PSA), duration of operation, intra-operative estimated blood loss, duration of drainage, recovery time of bowel movement, postoperative hospital stay, occurrence of complications, postoperative pathology (incidence of positive surgical margin and Gleason score), total hospitalization expenses and 3 months follow-ups of continence rate and blood PSA change, together with the workload, operating difficulty, image clarity and visual comfort for the operators and the cooperation workload for the nurses. Data analysis was performed by using SPSS 19.0 software, the comparisons of measurement data were analyzed using independent-sample t-test, the comparisons of enumeration data were analyzed using chi-square test or Fisher accurate probabilities, and a P value of< 0.05 was considered statistically significant.[Results]The demographic data were not significantly different between the 3-D laparoscopy and 2-D laparoscopy groups (P>0.05), which meant these two group of cases were comparable. All the 45 patients experienced successful operations under general anesthesia and there was no switch of surgery methods during the operation. The average duration of operation was 218.25±20.47min in 3-D group and 254.20±40.25min in 2-D group, with a significant difference (P=0.080). No case received blood transfusion intra- and post-operation. The intra-operative estimated blood loss was 130.00±57.12 ml in 3-D group and 194.00±119.30 ml in 2-D group, which the blood loss of 3-D was apparently less than 2-D group (P=0.041). The difference of the postoperative drainage duration between the two groups was statistically significant (7.20±2.14d,9.92±3.11d, respectively; P>0.028). No severe complications occurred intra-operatively. But 1 patient in 3-D group (5%) and 4 cases in 2-D group (16%) had lymphorrhagia, and 1 case in 2-D group (4%) occurred urine leakage postoperatively, without a significant difference (P>0.05). According to the pathological results of the two groups, there were no statistical differences in the rate of positive surgical margins and Gleason scores between the 3-D and 2-D groups (15%vs.20%,7.12±1.18 vs.7.44±0.92, respectively; P>0.05). The follow-up findings after 3 months presented a significantly higher rate of urinary continence in 3-D group than in 2-D group (85%vs.56%; P=0.037). The average total hospitalization expense was RMB 57217.91±7593.28 in 3-D group and RMB 58829.73±11089.31 in 2-D group, with no remarkable difference (P=0.701). Besides, the 3-D surgery possessed significantly lower workload (3.55±0.52 vs.4.09±0.54), lower operating difficulty (3.36±0.50 vs.4.18±0.40) and higher image clarity (4.64±0.50 vs.3.73±0.47) for the operators, but no significantly different workload of surgical assistance for the nurses from the 2-D surgery (3.00±1.20 vs.3.13±0.83).[Conclusion]Compared to the conventional 2-D laparoscopic technique,3-D laparoscopic technique manifested the advantages of shorter duration of operation, less intra-operative estimated blood loss, shorter post-operative drainage duration and hospital stay, better urinary continence, lower workload for operators together with lower operating difficulty, higher clarity of videos and great safety. Therefore,3-D laparoscopy is worthy to be widely used in various medical institutes.