Ergonomical assessment of three-dimensional versus two-dimensional thoracoscopic lobectomy.

In this study we compared ergonomical domains characteristics of three dimensional (3D) versus two dimensional (2D) video-systems in thoracoscopic lobectomy using a scoring-scale-based assessment. Seventy patients (mean age, 69±6.9 years, 43 males and 27 females) with early stage lung cancer were randomized to undergo thoracoscopic lobectomy by either 3D (N=35) or 2D (N=35) video-systems. All operations were divided into 5 standardized surgical steps (vein, artery, bronchus, fissure, lymph nodes), which were evaluated by 4 thoracic surgeons using a scoring scale (score range from 1,unsatisfactory to 3,excellent) entailing assessment of 3 ergonomical domains: exposure, instrumentation and maneuvering. Primary outcome was a difference ≥10% in the maneuvering domain steps. At intergroup comparisons, there was no difference in demographics. The 3D system results were better for maneuvering domain total score and particularly for the artery and bronchus steps scores (score≥10%, p≤0.006). Other significant differences included exposure of the vein, artery and bronchus (p≤0.03). Results favoring the 2D system included maneuvering, exposure and instrumentation of the fissure (p=0.001). Inter-rater concordance of ergonomics scoring was satisfactory (Cronbach's α range, 0.85-0.88). Operative time was significantly shorter in the 3D group (127±19min versus 143±18min, p=0.001) whereas there was no difference in hospital stay (3.4±1.2 versus 4.1±1.6days, p=0.07). In this study comparison of ergonomic domains scoring in 3D vs 2D thoracoscopic lobectomy favored the 3D system for the maneuvering total score, which proved inversely correlated with operative times possibly due to a better perception of depth and more precise surgical maneuvering.