Recommendations for 3D Laparoscopy in Abdominal Cavities in Children

 

3D Laparoscopy in Children

Laparoscopy has revolutionized the treatment of congenital and acquired abdominal diseases in children and has caused a reevaluation of many clinical strategies in pediatric surgery. FROM appearance cameras high permissions and high -quality screens, endosurgery has undergone significant changes in the field visualization of internal objects.

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Tem not less ordinary laparoscopy all yet It has restrictions. 2D (2D) visualization counts her main weakness. One of the main disadvantages of traditional laparoscopy is is an absence depth of perception. This omission corrects with appearance robot-assisted complexes, which first become use three dimensional (3D) image effect. The high cost of equipment and the lack of tactile feedback are certain limiting factors in robotic technology. Modern system 3D for fulfillment traditional thoracoscopic and laparoscopic surgery offers most of the advantages of robot-assisted surgery at a low system cost and opportunities use ordinary laparoscopic equipment.

Use of 3D Video Systems

However, 3D video systems not yet widely uses in surgery, especially in pediatric practice. This trend is due to main way topics what most pediatric surgeons are satisfied with the 2D imaging that exists with standard laparoscopy. Another explanation for this phenomenon is in absence before the present time of the necessary equipment for the implementation of 3D laparoscopy in children.

Pediatric surgeons faced from topics what available them 3D telescopes have diameter 10 mm, which the in force existing submissions is a big for children. IN present research we generalize own experience in laparoscopic surgery three- dimensional format at children And open veil above little studied area of application of this technology, demonstrating the possibility of its use for the correction of congenital anomalies in the development of the abdominal organs at an early age . group.

Material and Methods

At the surgery center, newborns from January 1 to December 31, 2014 on the treatment 48 patients that fulfill operations from using 3D laparoscopy. Everything children were grouped in dependencies from type surgical interventions, forming cohorts of patients: inguinal herniorrhaphy — 25; pyloromyotomy - 7; gastroesophageal reflux - 5; plastic pyeloureteral segment- that — 5; nephrectomy — 4; ovariocystectomy — 2.

A modern view on the production of laparoscopic operations in 3D format at children conclude involved in choosing the optimal equipment and implementation of practical skills, necessary for implementation of this approach.

Recommendations for 3D Laparoscopy

Our recommendations based on the own- nom experience, concern preferences type used endoscopic equipment for 3D laparoscopic operations at children, providing the endo-surgeon with maximum comfort:

·         use of 3D TIPCAM endoscopic video head with two distal CCD video sensors, direction of view 30° long 31 cm, which allows create optimal three-dimensional visualization internal them objects;

·         32" 3DLCD monitors (Healthcare), located false on the optical axes vision surgeon And distance not less 1.5 m from eye;

·         using 3D glasses (3D Viera) running on the principle circular polarization;

·         using a personal computer and a 3D video converter for recording and storage 3D movies

Need for gentle insertion The 10 mm optical system into the abdominal cavity proved to be the most difficult task. However, long experience in performing trans-umbilical open and single-port laparoscopic operations convinced us that the use of the navel as an invisible access for installation massive devices not accompanied by an additional risk of developing a wound infection , education postoperative hernia And cosmetic deformations.

Introduction of the Optical System

To overcome some inconvenience, we perform eversion of the umbilicus to the outside, dissection of the skin and aponeurosis of the umbilical region. Further introduction of the optical system into the abdominal cavity caused no difficulties. The free installation of the telescope facilitates by Availability physiological umbilical hernia at most small patients. The sealing of the umbilical incision carries out by applying 2-3 aponeurotic seams.

Results

The mean age of patients at the time of surgery was 51.75±39.57 (M ± SD) days (range: 7–175 days). The body weight of the patients was 4439.89±1362.62 (M ± SD) g (range: 3240–6915 g).

All endo-surgical interventions perform without conversion to traditional 2D laparoscopy or laparotomy. The first laparoscopic operations in 3D format were associated with the difficulties of getting used to the three-dimensional picture of the image, wearing glasses and adapting previous experience of traditional laparoscopy.

Technical Work in Abdominal Cavities

To new improved technical work in abdominal cavities. However, in In the course of accumulating experience, subjective sensations leaves behind, and the development of new endoscopic skills led to the preference for using 3D laparoscopy to correct a number of anomalies of the abdominal organs. We are not noted WHO- sinking additional inconvenience in progress performing end surgical operations; such how eye fatigue, dizziness, blurred vision, double vision, nausea, which could to be associated with the emergence of new visual impressions.

Depth perception and tactile feedback improved perception of anatomy domestic org- new and provides progress in implementation complex end surgical skills — internal sutures and knotting.

Laparoscopic 3D Interventions

The early period after laparoscopic 3D interventions proceeded without complications in all patients. We have not registered cases of infection wounds navel, inclined to this condition due to his depths and difficulties care.

Conclusion

Subsequent examinations of patients showed the absence of late postoperative complications in all children. Remote monitoring patients for at least 6 months after of surgical intervention reveals the reliability of the basic element of 3D laparoscopy in children — ultra-small umbilical access. It confirms on the absence of formation of postoperative umbilical hernia High aesthetics only, hidden in depth umbilical rings cut. It demonstrates excellent cosmetic results 3D-laparoscopy; as a result, the body patient not remained visible scars after installing 10 mm devices.

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