3D laparoscopy does not reduce operative duration or errors in day-case laparoscopic cholecystectomy: a randomised controlled trial

Abstract

Background Contemporary 3D platforms have overcome past deficiencies. Available trainee and laboratory studies suggest stereoscopic imaging improves performance but there is little clinical data or studies assessing specialists. We aimed to determine whether stereoscopic (3D) laparoscopic systems reduce operative time and number of intraoperative errors during specialist-performed laparoscopic cholecystectomy (LC). Methods A parallel arm (1:1) randomised controlled trial comparing 2D and 3D passive-polarised laparoscopic systems in day-case LC using was performed. Eleven consultant surgeons that had each performed > 200 LC (including > 10 3D LC) participated. Cases were video recorded and a four-point difficulty grade applied. The primary outcome was overall operative time. Subtask time and the number of intraoperative consequential errors as identified by two blinded assessors using a hierarchical task analysis and the observational clinical human reliability analysis technique formed secondary endpoints. Results 112 patients were randomised. There was no difference in operative time between 2D and 3D LC (23:14 min (± 10:52) vs. 20:17 (± 9:10), absolute difference − 14.6%, p = 0.148) although 3D surgery was significantly quicker in difficulty grade 3 and 4 cases (30:23 min (± 9:24), vs. 18:02 (± 7:56), p < 0.001). No differences in overall error count was seen (total 47, median 1, range 0-4 vs. 45, 1, 0-3, p = 0.62) although there were significantly fewer 3D gallbladder perforations (15 vs. 6, p = 0.034). Conclusion 3D laparoscopy did not reduce overall operative time or error frequency in laparoscopic cholecystectomies performed by specialist surgeons. 3D reduced Calot's dissection time and operative time in complex cases as well as the incidence of iatrogenic gallbladder perforation (NCT01930344).

Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure

“…3D laparoascopy was reported to shorten operative time and enhance depth perception in five randomised studies analysed for a systematic review [26]. However, a recent randomised trial by Schwab et al [27] concluded that 3D laparoscopy did not reduce overall operative time or error frequency in LC performed by specialist surgeons. In agreement with our findings, they observed that case difficulty, according to the Nassar Scale, was a major confounding variable with a larger impact on operative time than the imaging system used.…”

Achieving Critical View of Safety via a New Technique: The Triple One (111) Technique

“…As lap chole's learning curve smoothed out, the incidence of VBI stayed under control and no such leak was seen throughout the entire trial period [ 8 , 9 ]. However, according to recent data, mortality and morbidity have not altered considerably, but BDI has been increasing for a number of years (0.32 to 0.52) [ 10 , 11 ].…”

Two- and three-dimensional laparoscopic donor nephrectomy: a comparative study of a single-center experience

“…Some researchers have pointed out the obvious superiority of 3D laparoscopy over 2D laparoscopy for complex surgery (e.g., oncological, urological, and bariatric surgery) [ 19 - 21 ]. However, some randomized studies revealed no differences in the performance of cholecystectomy, hernioplasty, or appendectomy between these two laparoscopic methods [ 22 , 23 ]. We consider laparoscopic donor nephrectomy to be one of the most complex operations; moreover, in this procedure, healthy donors with altruistic motivations are subjected to surgical interventions and risks without any expected therapeutic effects.…”