Minimally invasive laparoscopic surgery into the 3D era

Minimally invasive laparoscopic surgery into the 3D era Ruijin Hospital takes the lead in three-dimensional field of vision operation, superior visual effects bring greater safety

In the busy and nervous operating room, the surgeons wore "3D sunglasses". The two doctors held the robotic arm and looked up the movement in the patient's abdominal cavity on the display. Different from the past, on this display labeled "3DHD", the abdominal organs and blood vessels are well-defined, just like watching a 3D movie.

Yesterday morning, in the operating room of Shanghai Ruijin Hospital, doctors were giving an 84-year-old woman a bowel cancer radical surgery. This is the second patient who has undergone 3D high-definition laparoscopic surgery in China. It was here five days ago and completed the first 3D high-definition laparoscopic surgery in China.

The application of 3D high-definition technology to the clinic is regarded by the international medical community as the future of minimally invasive surgery visualization. Its superior visual effect means faster and more accurate surgical operation, less complications and higher safety.

New problems after not "opening"

"Can you give me a pair of glasses to see the effect? ​​Well, the vision is really different! If used for our pelvic lymphadenectomy, the effect must be very good, the traditional screen is two-dimensional, can not see clearly." 8 am yesterday , Ruijin Hospital Branch, Shanghai Mini-invasive Surgery Clinical Medical Center, a holistic operating room, just an empty obstetrician and gynecologist came to observe the "new weapon" - 3D minimally invasive laparoscopic surgery. Technological advances always make surgeons eager to try.

Today, laparoscopic surgery is always closely related to the word "minimally invasive". Fill the patient's abdominal cavity with a certain amount of inert gas to make it slightly bulge, creating a spacious space for the operation; then, three small hole-sized holes are equally spaced around the patient's navel to insert the surgical arm. Start surgery... This is the classic preparation for laparoscopic surgery. Since the end of the last century, this kind of minimally invasive surgery has been introduced into the country. Because of its small incision, low amount of bleeding, short operation time, and low hospitalization days, it has gradually become the patient's first choice. Traditional open surgery has retreated to the second line.

However, when the surgical laparotomy turned to the "keyhole" minimally invasive surgery - the incision was getting smaller and smaller, shrinking to 0.5-1.0 cm, or even 0.2 cm, the surgeons who observed the abdominal cavity through the display realized the new problem: in the second On the screen, the organs, tissues, and blood vessels that originally had the context are on the same plane. Doctors operating through the robotic arm are likely to "walk the wrong way" or "docked out."

"The occurrence of dislocations means that it may increase the amount of bleeding, prolong the operation time, and even increase the complications, affecting the prognosis of surgery." Vice President of Ruijin Hospital, Professor Zheng Minhua, director of Shanghai Minimally Invasive Surgery Clinical Medicine Center said. He is the chief surgeon in the first and second cases of 3D high-definition laparoscopic surgery in China.

Doctor wearing 3D glasses for surgery

In the new 3D HD laparoscopic surgery, the change first appeared on the laparoscope. The original 1 cm diameter imaging lens was changed to the left and right lens, which is equal to two miniature cameras. They are matched with the polarizer worn by the doctor. The doctor saw the 3D visual effect on the display. In addition to the 3D effect, the display labeled "3DHD" has a video resolution of 1080P.

Zheng Minhua said that 3D HD technology has especially improved the perception of depth by laparoscopic doctors, which is not possible with 2D visual effects.

In medical school, medical students learn human anatomy, which is three-dimensional; but because of the clinical application of laparoscopic surgery over the past decade, they have witnessed the two-dimensional world on the screen. The process of re-recognizing the anatomy is very uncomfortable for beginners.

"The human body is a three-dimensional world. Today's technology is to restore the three-dimensional world in the body based on the smallest wound." The international medical community has the opinion that the 3D high-definition effect allows surgeons to better observe the fine vascular structure, and these The blood vessels in the structure pulsate and help the doctor identify more quickly, thereby reducing the risk of accidental damage to the blood vessels to a greater extent. In addition, it provides hardware preparation for more complex procedures, including operations involving the liver, stomach, and pancreas.

Technological progress, basic skills decline?

Currently, 3D high-definition laparoscopic surgery is suitable for all patients who are eligible for laparoscopic surgery without increasing the financial burden. "The cost is the same as the cost of laparoscopic surgery." Zheng Minhua said.

In the United States, Professor Timothy Locke of the Colorectal Department of the University of Surrey bluntly said: "If you can perform three-dimensional vision surgery, how can someone choose two-dimensional field surgery? You know how many surgeons are trying to complete some In the complicated operation, I have to close one eye? It is time to perform minimally invasive surgery in the three-dimensional field of view." As the leader of the Laparoscopic and Endoscopic Surgery Team of the Chinese Medical Association, Zheng Minhua became the whole minimally invasive surgery for 3D high-definition laparoscopic surgery. The direction of the discipline and the attitude are cautious. "It should be just an innovative component, not a direction."

It is reported that at the recent German Electronics Show, there have been holographic camera technologies achieved by 700 cameras, which can present the anatomical position of 360, which is of great significance for complex and difficult operations involving liver, stomach and pancreas. In addition, at present, above 1080P, there is also a 4K Ultra HD resolution. “Minimally invasive technology has entered a new platform period, and the emergence of many new technologies is helping surgeons better achieve clinical goals, but it is hard to say where the future is going.”

In fact, there is controversy about 3D high-definition laparoscopic surgery. One view is that the original two-dimensional screen allows doctors to exercise a “feeling experience” in actual combat – even in areas that are invisible to the human body, they still have an anatomical structure and reach the target position by hand touch. A clear three-dimensional screen may leave the surgeon's basic skills a waste. However, just as "the computer ruined computing power and the computer ruined a good word", no one can deny the contribution that these technological advances bring to humanity.

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