Abstract
BackgroundLaparoscopic 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.MethodsPatients 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.ResultsOne 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.ConclusionsA 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system.
Highlights
Materials and methodsA randomised-controlled trial was conducted, with the primary outcome being time to complete laparoscopic cholecystectomy
Laparoscopic surgery has well-established benefits for patients; laparoscopic procedures have a long and difficult learning curve, in large part due to the lack of stereoscopic depth perception
There were no differences in preoperative patient characteristics, indications for surgery or gallbladder grade between groups (Table 1)
Summary
A randomised-controlled trial was conducted, with the primary outcome being time to complete laparoscopic cholecystectomy. A power calculation was based on a median operating time for laparoscopic cholecystectomy of 47 min (range 36–64 min) [15, 16]. With 46 patients in each treatment arm, the study had 80% power to detect a 12-min (25%) difference in operative time, with statistical significance declared if p < 0.05. Videos were graded by the Principal Investigator in consensus with a blinded surgeon who had not been involved in the trial This surgeon conducted the error assessment using the Technical Skills Checklist error score [17]. This involved calculating a weighted score for minor (bile spillage, diathermy burn to liver, incomplete clipping, fallen clip, delay in identifying Calot’s triangle anatomy), major (stone spillage, injury causing liver bleeding, injury to cystic artery or duct, loss of pneumoperitoneum), and significant major (major vessel or major duct injury, other visceral injury) errors. This trial was registered (NCT02858986) and approved by the Health Research Authority and Oxford B Research Ethics Committee (16/SC/0414)
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