3D laparoscopy is associated with a better surgical outcomes in choledocholithiasis patients with abdominal adhesions compared with 2D: a propensity score analysis

Abstract

Introduction: Despite the advantages of 3D laparoscopy was reported, the effect of 3D laparoscopy in choledocholithiasis remained unclear. This study was designed to investigate whether 3D laparoscopy could improve surgical outcomes in choledocholithiasis patients with abdominal adhesions. Method: In this retrospective study, patients underwent 2D or 3D LCBDE between 2012 and 2017 were enrolled. After propensity score match and multivariate analysis, the risk factors for operation time and conversion rate were identified. Result: 213 patients underwent 3D LCBDE and 212 patients receiving 2D LCBDE were enrolled this study. The operation time and blood loss in 3D group were significantly less than that in 2D group (110±30.64min vs 133.02±32.03min, P<0.001; 29.92±35.61ml vs 43.60±38.86ml, P<0.001, Table 2). In addition, conversion to open occurred in 18 (8.5%) and 32 (15.1%) respectively and were significantly decreased in 3D group patients compared to 2D group patients. After propensity score matching, a total of 114 matched cases were selected from the 2 groups. The operation time (111.35±36.11min vs 130±29.02min, P<0.001) and blood loss (30.82±35.16ml vs 47.98±43.67ml, P=0.001) in 3D group remain significantly lower than in 2D group. Moreover, the incidences of conversion (8 vs 20, P=0.015) were significantly decreased in 3D group compared with 2D group patients. In the multivariate analysis, 3D operation (HR:0.107, 95%CI: 0.018-0.624; P=0.013), Times of endoscopic retrograde cholangiopancreatography (ERCP) (HR:5.723, 95%CI: 2.537-12.908; P<0.001) and months of right upper abdominal pain (RUAP) (HR:1.129, 95%CI: 1.044-1.221; P=0.002) were independently associated with conversion to laparotomy. Conclusion: 3D laparoscopy would significantly reduce operation time, blood loss and conversion rate in patients with moderate abdominal adhesions. Multiple times of ERCP and prolonged RUAP were independent risk factors to increase conversion rate.