The Clinical Study On Applying Three-Dimensional Laproscopic Vision Technology In The Department Of Urology

Research Goal:1.to summarize the single-center clinical effects and experiences of applying 3 D high resolution laparoscopic technology to 59 cases of patients in the Department of Urology2.to summarize the surgical experiences and clinical effects of 18 cases of single port 3D multi-channel laparoscopic operation in the Department of Urology in order to explore the advantages and feasibility of 3D multi-channel laparoscopic operation as well as the prospect of its application in urology.3.to compare clinical outcomes of 3D laparoscopic nephron sparing surgery for renal tumors with those of conventional 2D laparoscopic surgery.Research Methods:1 Analyzed in retrospect 59 cases of 3 D high resolution laparoscopic surgery in our department from August 2013 to November 2014,including 1 case of removal of functionless kidney,13 cases of radical nephrectomy,19 cases of partial nephrectomy 10 cases of unilateral adrenalectomy and 6 cases of Pyeloplasty,3 cases of kidney cyst operation,5 cases of radical prostatectomy for prostate cancer,1 case of radical cystectomy and 1 case of repeat nephrectomy.Collected and analyzed related perioperative period data of the patients including age,body mass index(BMI),surgery time,intraoperative blood loss(BLE),the hospitalization time after operation,the postoperative intestinal recovery time and ASA rating as well follow-up clinical data after the surgery2 2 Collected the clinical data of 18 cases single-port multi-channel 3 D laparoscopic surgery in our hospital from August 2013 to November 2014,including 5cases of radical nephrectomy,8 cases of adrenalectomy,3 cases of functionless kidney removal,1 case of retroperitoneal cyst excision and 1 case transabdominal partial nephrectomy.The statistics collected included age,body mass index(BMI),surgery time,intraoperative blood loss(BLE)and other perioperative period data.Related preoperative examinations and preparations for laparoscopic surgery has been conducted according to the routines3 Clinical data on 85 patients who under—went laparoscopic nephron sparing surgery for renal tumors were collected.After the process of strict entry and screening for exclusion criteria,the patients were divided into observation group and control group.The observation group included 19 cases,who received 3D laparoscopic nephron sparing surgery.The control group included 19 cases,who received traditional laparoscopic nephron sparing surgery.Demographic data,perioperative parameters and clinical outcomes were collected and compared between the 2 groupsResults:1.Only one case of resort to open abdominal operation occurred among 59 cases of laparoscopic operation,reaching a very high success rate of 98.3%.The mean age of the patients involved in this research project turns out to be 51.7±13.32 years old,with their mean body mass index(BMI)at 24.2±3.12(17.6-32.1)kg/m2,mean surgery time in 199.7±94.26(80-525)minutes,mean intraoperative blood loss(BLE)at153.7±157.45(0-1000)ml,the mean postoperative intestinal recovery time in 2.5± 1.93(1-15)days,the mean hospitalization time after operation in 2.5±1.93(1-15)days.Meanwhile,overall incidence of complications of the operation amounts to be 11.8%,with the incidence of intraoperative complications at 5%,the incidence of postoperative complications at 6.8%.The intraoperative complications included one case of bleeding in unilateral adrenalectomy,one case of bleeding in radical nephrectomy and still one case of bleeding in partial nephrectomy.The postoperative complications included 2 cases in partial nephrectomy,particularly one case of postoperative infection and one case of pulmonary embolism as well as one case of secondary hemorrhage in radical nephrectomy and one case of intestinal obstruction in radical prostatectomy.2.All the 18 cases of single port laparoscopic 3D operation achieved success,without any case of resort to open abdominal operation or postoperative complications.According to the statistics,the mean age of the patients involved in this research project turns out to be 55.9±11.80(31-69)years old,with their mean body mass index(BMI)at24.8±3.41(18.5-28.9)kg/m2,mean surgery time in 135.5±58.28(87-175)minutes,mean intraoperative blood loss(BLE)at 138.9±130.51(20-400)ml,the mean postoperative intestinal recovery time in 2±0.67(1-3)days,the mean hospitalization time after operation in 4.4±1.38(3-7)days.3.Both groups achieved success in surgery.The warm ischemia time of the 3D Group turns out 16.3±4.2min whereas that of the 2D Group turns out 17.2±3.2min,demonstrating statistically significant differences(P<0.05).In the observation group such perioperative parameters as operative time and the estimated blood loss as well as postoperative intestinal recovery time were not significantly different from those of control group(P>0.05).Two cases of complications in each group have been observed,but they have been cured with expectant treatment.No tumor recurrence or metastasis has been reported in the postoperative follow-ups for 3-11 months.Summary:1.Compared with 2D laparoscopic technology,3D high-resolution laparoscopic technology demonstrates obvious advantages in the clinical operations of the Department of Urology.The merits are mainly manifested in its 3 dimensional perspective: 1)anatomical landmarks and levels are illustrated very clearly,minimizing the probability of negative damage in precise operations.2)The difficulty of laparoscopic operations like suturing and knot tying can be largely reduced,shortening the operation time to a certain extent.3)It even helps to shorten the learning curve of laparoscopic operations whereas the system does add to the financial concerns of the patients.Thus it is worth promoting in a developing country like China.2.The single port 3D laparoscopic technology is highly reliable in that it lowers the difficulty level of single port laparoscopic surgery with the combined merits of the overall perspective and the precision in operations,while at the same time maintains the advantages of small trauma and quick recovery.Its clinical prospect is very promising and is very much worth promoting in our field.3.Compared with the conventional 2D laparoscopic technology,3D laparoscopic technology has no obvious advantage in spatial location and the sense of depth.Total operation time and blood loss have not been reduced,either.Yet,3D laparoscopy reduces the operation difficulty and renal warm ischemia time.