Three-Dimensional Versus Two-Dimensional Laparoscopic-Assisted Transanal Pull-Through for Hirschsprung's Disease in Children: Preliminary Results of a Prospective Cohort Study in a Tertiary Hospital.

BACKGROUND: This prospective cohort study is aimed to compare the efficacy and safety of three-dimensional (3D) versus two-dimensional (2D) laparoscopy in laparoscopic-assisted transanal pull-through (LATP) for the surgical treatment of Hirschsprung's disease (HD) in children.

METHODS: This study enrolled 80 children who were histologically diagnosed with HD and undergone LATP performed by a single experienced surgeon at our department between January 2015 and November 2017. Children were randomized to receive 2D laparoscopy (n = 40) or 3D laparoscopy (n = 40). Data on patient characteristics, operative parameters, and the surgeon's assessment on utilization of laparoscopic system were prospectively recorded and analyzed.

RESULTS: Patient characteristics, including age at surgery, gender, weight, and the level of aganglionosis, were comparable between the two groups (each P > .05). Compared with 2D imaging system, 3D system significantly shortened the performance time of laparoscopic phase (27.0 ± 3.6 minutes versus 38.3 ± 4.3 minutes, P < .001) with a 29.5% reduction, and the total time of the entire surgery (106.0 ± 19.5 minutes versus 122.1 ± 18.7 minutes, P < .001). No statistical difference was observed in terms of estimated intraoperative blood loss and intraoperative laparoscopic complications between the two groups (each P > .05). In addition, 3D system significantly improved depth perception and precision, and reduced surgical strain for the surgeon.

CONCLUSIONS: 3D LATP is feasible and safe in the surgical treatment of HD in children. Further studies are still needed to investigate the application of 3D in both experienced and inexperienced surgeons.