After a Health Technology Assessment on 3D vision technology completed last year, the aim of one of the consensus meetings 2018 of the EAES was to generate a guideline on the same topic based on best available evidence and expert opinions of EAES Technology Committee members. After a systematic review of the literature by an international group of research fellows, an expert panel with extensive engineering and clinical experience in the use of 3D vision technology discussed statements and recommendations. Twenty-two statements and 2 recommendations were obtained unanimously by the experts and were discussed and voted at the consensus meeting of the EAES in London in May 2018 by the attendees of the meeting. The most important regarding general topics were: a) 3D vision improves outcomes for junior trainees in performing standardized tasks in box trainers, only when 3D systems with HD screen and passive polarized glasses are used and only when properly set up; b) The use of 3D imaging systems improves laparoscopic box trainer task completion time and error rate but this benefit has not been studied in clinical practice. The most important regarding clinical setting were: a) 3D laparoscopy shortens the operating time in all the analysed surgical settings (general surgery, urology and gynaecology); b) The pooling of data from the different settings seems to suggest a lowering in the overall rate of complications after surgical procedures involving suturing in 3D laparoscopy, especially in the gynaecology setting; indeed data are too heterogeneous and weak to sustain any recommendation, other than implications for future research. These produced 2 recommendations: a) 3D laparoscopy might shorten operative times; b) Future research is recommended to demonstrate that 3D vision may lower complications rate in laparoscopy. The majority of the EAES members supported these statements.These consensus proceedings provide additional guidance to surgeons and surgical residents providing help when using 3D vision technology.
Background. Hyperspectral imaging (HSI) is a relatively new method used in image-26 guided and precision surgery, which has shown promising results for characterization 27 of tissues and assessment of physiologic tissue parameters. Previous methods used 28 for analysis of preconditioning concepts in patients and animal models have shown 29 several limitations of application. The aim of this study was to evaluate HSI for the 30 measurement of ischemic conditioning effects during esophagectomy. 31 Methods. Intraoperative hyperspectral images of the gastric tube through the mini-32 thoracotomy were recorded from n=22 patients, 14 of whom underwent laparoscopic 33 gastrolysis and ischemic conditioning of the stomach with two-step transthoracic 34 esophagectomy and gastric pull-up with intrathoracic anastomosis after 3-7 days. 35 The tip of the gastric tube (later esophago-gastric anastomosis) was measured with 36 HSI. Analysis software provides a RGB image and 4 false color images representing 37 physiologic parameters of the recorded tissue area intraoperatively. These parameters contain tissue oxygenation (StO2), perfusion-(NIR Perfusion Index), 1 organ hemoglobin-(OHI) and tissue water index (TWI). 2 Results. Intraoperative HSI of the gastric conduit was possible in all patients and did 3 not prolong the regular operative procedure due to its quick applicability. In particular, 4 the tissue oxygenation of the gastric conduit was significantly higher in patients who 5 underwent ischemic conditioning (StO2Precond. = 78%; StO2NoPrecond. = 66%; p = 0.03). Conclusions. HSI is suitable for contact-free, non-invasive and intraoperative 7 evaluation of physiological tissue parameters within gastric conduits. Therefore HSI is 8 a valuable method for evaluating ischemic conditioning effects and may contribute to 9 reduce anastomotic complications. Additional studies are needed to establish normal 10 values and thresholds of the presented parameters for the gastric conduit 11 anastomotic site.
No post-application bleeding was seen. No postoperative hemorrhagic complications occurred. A significant reduction in blood loss and in surgical time was noted. CONCLUSIONS; We believe that the LVSS could be extremely useful in all the fields of hepatopancreatobiliary surgery, especially in patients with portal hypertension with large intestinal and omental varices. The LVSS guarantees excellent hemostasis, reducing the risk of serious blood loss and shortening the time of surgery, so improving the prognosis.
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