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Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial.

Abstract

BACKGROUND

Laparoscopic surgery has well-established benefits for patients; however, laparoscopic procedures have a long and difficult learning curve, in large part due to the lack of stereoscopic depth perception. Developments in high-definition and stereoscopic imaging have attempted to overcome this. Three-dimensional high-definition (3D HD) systems are thought to improve operating times compared to two-dimensional high-definition systems. However their performance against new, ultra-high-definition ('4K') systems is not known.

METHODS

Patients undergoing laparoscopic cholecystectomy were randomised to 3D HD or 4K laparoscopy. Operative videos were recorded, and the time from gallbladder exposure to separation from the liver (minus on table cholangiogram) was calculated. Blinded video assessment was performed to calculate intraoperative error scores.

RESULTS

One hundred and twenty patients were randomised, of which 109 were analysed (3D HD n = 54; 4K n = 55). No reduction in operative time was detected with 3D HD compared to 4K laparoscopy (median [IQR]; 23.41 min [17.00-37.98] vs 20.90 min [17.67-33.03]; p = 0.91); nor was there any decrease observed in error scores (60 [56-62] vs 58 [56-60]; p = 0.27), complications or reattendance. Stone spillage occurred more frequently with 3D HD, but there were no other differences in individual error rates. Gallbladder grade and operating surgeon had significant effects on time to complete the operation. Gallbladder grade also had a significant effect on the error score.

CONCLUSIONS

A 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system.

Authors+Show Affiliations

Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK. matthew.dunstan@doctors.org.uk.Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31321536

Citation

Dunstan, Matt, et al. "Is 3D Faster and Safer Than 4K Laparoscopic Cholecystectomy? a Randomised-controlled Trial." Surgical Endoscopy, 2019.
Dunstan M, Smith R, Schwab K, et al. Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial. Surg Endosc. 2019.
Dunstan, M., Smith, R., Schwab, K., Scala, A., Gatenby, P., Whyte, M., ... Jourdan, I. (2019). Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial. Surgical Endoscopy, doi:10.1007/s00464-019-06958-w.
Dunstan M, et al. Is 3D Faster and Safer Than 4K Laparoscopic Cholecystectomy? a Randomised-controlled Trial. Surg Endosc. 2019 Jul 18; PubMed PMID: 31321536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial. AU - Dunstan,Matt, AU - Smith,Ralph, AU - Schwab,Katie, AU - Scala,Andrea, AU - Gatenby,Piers, AU - Whyte,Martin, AU - Rockall,Tim, AU - Jourdan,Iain, Y1 - 2019/07/18/ PY - 2019/03/02/received PY - 2019/07/01/accepted PY - 2019/7/20/entrez KW - Cholecystectomy KW - Depth Perception KW - Imaging KW - Laparoscopy KW - Three-Dimensional JF - Surgical endoscopy JO - Surg Endosc N2 - BACKGROUND: Laparoscopic surgery has well-established benefits for patients; however, laparoscopic procedures have a long and difficult learning curve, in large part due to the lack of stereoscopic depth perception. Developments in high-definition and stereoscopic imaging have attempted to overcome this. Three-dimensional high-definition (3D HD) systems are thought to improve operating times compared to two-dimensional high-definition systems. However their performance against new, ultra-high-definition ('4K') systems is not known. METHODS: Patients undergoing laparoscopic cholecystectomy were randomised to 3D HD or 4K laparoscopy. Operative videos were recorded, and the time from gallbladder exposure to separation from the liver (minus on table cholangiogram) was calculated. Blinded video assessment was performed to calculate intraoperative error scores. RESULTS: One hundred and twenty patients were randomised, of which 109 were analysed (3D HD n = 54; 4K n = 55). No reduction in operative time was detected with 3D HD compared to 4K laparoscopy (median [IQR]; 23.41 min [17.00-37.98] vs 20.90 min [17.67-33.03]; p = 0.91); nor was there any decrease observed in error scores (60 [56-62] vs 58 [56-60]; p = 0.27), complications or reattendance. Stone spillage occurred more frequently with 3D HD, but there were no other differences in individual error rates. Gallbladder grade and operating surgeon had significant effects on time to complete the operation. Gallbladder grade also had a significant effect on the error score. CONCLUSIONS: A 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/31321536/Is_3D_faster_and_safer_than_4K_laparoscopic_cholecystectomy_A_randomised-controlled_trial L2 - https://dx.doi.org/10.1007/s00464-019-06958-w DB - PRIME DP - Unbound Medicine ER -