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.

Keywords: Cholecystectomy; Depth Perception; Imaging; Laparoscopy; Three-Dimensional.

Fig. 1

Consort diagram

Fig. 2

Time to complete laparoscopic cholecystectomy by view. Circles denote values 1.5–3 times the interquartile range

Fig. 3

Time to complete laparoscopic cholecystectomy by consultant. Circles denote values 1.5–3 times the interquartile range. Asterisks denote values more than 3 times outside the interquartile range

Fig. 4

Error score during laparoscopic cholecystectomy by view. Circles denote values 1.5–3 times the interquartile range (note: overlapping outliers—four in total for 4K view)