Evaluation of 3D Visualization for Total Colectomy

Three-dimensional (3D) visualization technology for laparoscopy has been proposed, since the
early 1990's, as a method to facilitate laparoscopic performance. However, early 3D
laparoscopic technology was limited in terms of image quality, so that its use had not been
implemented. The latest technical developments ensure high-definition 3D visualization with
the same quality that current two-dimensional (2D) systems provide.

The anticipated advantages of 3D laparoscopic visualization for the surgeon are greater
accuracy and speed in manual skills, translating to decreased operative time, reduced
learning curve, and superior safety . It was reported that, 3D laparoscopic visualization
offers significant advantages in enhancing laparoscopic performance, even in novice surgeons,
comparing to the 2D systems . We hypothesize that 3D visualization may allow surgeons to
reduce the overall operating time with a rate of 10% with comparable perioperative and
postoperative outcomes. The primary endpoint of this study is to determine the feasibility of
the laparoscopic approach using 3D visualization in the surgical treatment of ulcerative
colitis. Secondary endpoints are to determine whether 3D visualization confers benefits such
as reduced operating time and intra-operative complications with comparable postoperative
outcomes.

Device Description: The EXERA III Universal Platform will be used in this study, in
conjunction with the ENDOEYE FLEX 3D. The ENDOEYE FLEX 3D can also be used in 2D mode, by
utilizing a programmed button on the handle of the scope, or by using the 2D/3D button on the
3D Visualization Unit. The articulating tip of the ENDOEYE FLEX allows for the scope to be
used in both single-site and multi-port procedures, providing critical views and allowing a
bird's eye view so that the scope is out of the way of other instruments (while still
capturing the image at the surgical site). All equipment used in this trial has been cleared
under 510(k) approval by the FDA, and has been on the market in the US since April 2013.

The Olympus HD 3D Laparoscopic Surgical Video System consists of the following components:

- CV-190 Processor

- CLV-190 Light Source

- 3DV-190 3D Visualization Unit

- LMD-2451MT/3G4 Sony 24" 3D Monitor

- IMH-20 Image Capture System

- UHI-4 Insufflator

- K10021611 Cart

- OL-0015-08 Tall Rollstand

- LTF-190-10-3D ENDOEYE FLEX 3D Videoscope

- 3D glasses (regular and clip-on styles)

Study Size:Mean operating time for laparoscopic subtotal colectomy for medically refractory
UC was reported longer with a comparison to open surgery in the recently published studies.

Therefore the effort to decrease operating time in laparoscopic colectomy has gained
importance. We assumed that, in order to be able to determine a 10% reduction in mean
operating time, each group should include 27 patients (80% power and 5% significance).

Patients who will undergo laparoscopic total abdominal colectomy (TAC) for UC will be
included in the study. All subjects will be randomized into two groups: 3D laparoscopy, and
2D laparoscopy. Three staff surgeons (EG, HK, FR) at the department of colorectal surgery,
Cleveland Clinic, Ohio will perform the procedures with 2D and 3D laparoscopy. Each surgeon
will perform 9 total colectomies with 3D, and 9 total colectomies with the 2D laparoscopy
system. In total, 54 patients will be included (27 patients for each group).

Inclusion Criteria:

- Indication for surgery must be Ulcerative Colitis

- Patient age between 18 and 80

- Elective procedure

- BMI between 17 and 30

- Total colectomy with end ileostomy, without proctectomy

Exclusion Criteria:

- Any preoperative diagnosis other than UC

- Patient age< 18, or >80

- Emergency surgery

- Previous gastrointestinal surgery

- BMI>30

- Pregnancy

- Presence of any gastrointestinal tract malignancy

- Segmental colon resections, completion proctectomy, total proctocolectomy, pouch
procedures