4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial

S Restaino, V Vargiu, A Rosati, M Bruno, G Dinoi, E Cola, R Moroni, G Scambia, F Fanfani, S Restaino, V Vargiu, A Rosati, M Bruno, G Dinoi, E Cola, R Moroni, G Scambia, F Fanfani

Abstract

Background: The introduction of ultra-high-definition laparoscopic cameras (4K), by providing stronger monocular depth perception, could challenge the existing 3D technology. There are few available studies on this topic, especially in gynaecological setting.

Objectives: Prospective, single institution, randomised clinical trial (NCT04209036).

Materials and methods: The two laparoscopes utilised were the 0°ULTRA Telescopes with 4K technology and the 0°3D-HD by Olympus. The surgeons were all trainees and in their last year of residency and who had obtained the certificate of first or second level of the Gynaecological Endoscopic Surgical Education and Assessment program - GESEA program. Twenty-nine patients with benign uterine pathology were enrolled.

Main outcome measures: To compare if the use three-dimensional (3D) versus ultra-high-definition laparoscopic vision system (4K) for total laparoscopic hysterectomy performed by trainees was associated with a shorter operative time.

Results: The 3D vision system did not prove to be superior to the 4K vision system. Operators reported significantly more vision-related side effects when using 3D than 4K. Completing the GESEA training program was the only factor with a positive and statistically significant impact on the overall time of the procedure, especially when greater dexterity and tissue handling were required.

Conclusions: Neither technology used proved superior to the other, although operators showed a preference for 4K over 3D due to the lower number of visual side effects. Attendance at courses on laparoscopic simulators and training programs allowed trainees to demonstrate excellent surgical skills.

Figures

Figure 1
Figure 1
Flow-chart.

References

    1. Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;Issue 8:Art. No.: CD003677
    1. Abdelrahman M, Belramman A, Salem R, et al. Acquiring basic and advanced laparoscopic skills in novices using two-dimensional (2D), three-dimensional (3D) and ultra-high definition (4K) vision systems: A randomized control study. Int J Surg. 2018;53:333–338.
    1. Ahlborg L, Hedman L, Nisell H, et al. Simulator training and non-technical factors improve lap-aroscopic performance among OBGYN trainees. Acta Obstet Gynecol Scand. 2013;92:1194–1201.
    1. Ajao MO, Larsen CR, Manoucheri E, et al. Two-dimensional (2D) versus three-dimensional (3D) laparoscopy for vaginal cuff closure by surgeons-in-training: a randomized controlled trial. Surg Endosc. 2020;34:1237–1243.
    1. Arezzo A, Vettoretto N, Francis NK, et al. The use of 3D laparoscopic imaging systems in sur-gery: EAES consensus development conference 2018. Surg Endosc. 2019;33:3251–3274.
    1. Bertolo R, Checcucci E, Amparore D, et al. Current status of three-dimensional laparoscopy in urology: an ESUT systematic review and cumulative Analysis. J Endourol. 2018;32:1021–1027.
    1. Campo R, Wattiez A, Tanos V, et al. Gynaecological endoscopic surgical education and assessment. A diploma programme in gynaecological endoscopic surgery. Eur J Obstet Gynecol Reprod Biol. 2016;199:183–186.
    1. Chapron C, Fauconnier A, Goffinet F, et al. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod. 2002;17:1334–1342.
    1. Curtis NJ, Conti JA, Dalton R, et al. 2D versus 3D laparoscopic total mesorectal excision: a developmental multicentre randomised controlled trial. Surg Endosc. 2019;33:3370–3383.
    1. Dunstan M, Smith R, Schwab K, et al. Is 3D faster and safer than 4K laparoscopic cholecystec-tomy? A randomised-controlled trial. Surg Endosc. 2020;34:1729–1735.
    1. Fagotti A, Perelli F, Pedone L, et al. Current recommendations for minimally invasive surgical staging in ovarian cancer. Curr Treat Options Oncol. 2016;17:3.
    1. Fanfani F, Restaino S, Monterossi G, et al. Three-dimensional versus two-dimensional radical laparoscopic hysterectomy for endometrial and cervical cancer: a prospective randomized tri-al. J Minim Invasive Gynecol. 2015;22:38.
    1. Fanfani F, Rossitto C, Restaino S, et al. How technology can impact surgeon performance: a randomized trial comparing 3-dimensional versus 2-dimensional laparoscopy in gynecology oncology. J Minim Invasive Gynecol. 2016;23:810–817.
    1. Fergo C, Burcharth J, Pommergaard HC, et al. Age is highly associated with stereo blindness among surgeons: a cross-sectional study. Surg Endosc. 2016;30(11):4889–4894.
    1. Gala R, Orejuela F, Gerten K, et al. Effect of validated skills simulation on operating room per-formance in obstetrics and gynecology residents: a randomized controlled trial. Obstet Gynecol. 2013;121:578–584.
    1. Gueli Alletti S, Capozzi VA, Rosati A, et al. Laparoscopy vs. laparotomy for advanced ovarian cancer: a systematic review of the literature. Minerva Med. 2019;110:341–357.
    1. Gueli Alletti S, Restaino S, Finelli A, et al. Step by step total laparoscopic hysterectomy with uterine arteries ligation at the origin. J Minim Invasive Gynecol. 2020;27:22–23.
    1. Harada H, Kanaji S, Hasegawa H, et al. The effect on surgical skills of expert surgeons using 3D/HD and 2D/4K resolution monitors in laparoscopic phantom tasks. Surg Endosc. 2018;32:4228–4234.
    1. Kanaji S, Watanabe R, Mascagni P, et al. Three-dimensional imaging improved the laparoscop-ic performance of inexperienced operators: a prospective trial. Surg Endosc. 2020;34:5083–5091.
    1. Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–685.
    1. Ko JK, Li RH, Cheung VY, et al. Two-dimensional versus three-dimensional laparoscopy: eval-uation of physicians’ performance and preference using a pelvic trainer. J Minim Invasive Gy-necol. 2015;22:421–427.
    1. Koppatz HE, Harju JI, Sirén JE, et al. Three-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study. Surg Endosc. 2020;34:4857–4865.
    1. Larsen CR, Soerensen JL, Grantcharov TP, et al. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ. 2009;338
    1. Lobão Gonçalves AL, Ayroza-Ribeiro HA, Lima RF, et al. The impact of systematic laparoscopic skills and suture training on laparoscopic hysterectomy outcomes in a Brazilian teaching hospital. [o impacto do treinamento laparoscópico sistematizado de habilidades e sutura nos resultados da histerectomia laparoscópica em hospital universário brasileiro]. Rev Bras Ginecol Obstet. 2019;41:718–725.
    1. Lui MW, Cheung VY. Three-dimensional versus two-dimensional laparoscopy for ovarian cys-tectomy: a prospective randomised study. Hong Kong Med J. 2018;24:245–251.
    1. Mais V, Ajossa S, Guerriero S, et al. Laparoscopic versus abdominal myomectomy: a prospec-tive, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996;174:654–658.
    1. Murphy AA, Nager CW, Wujek JJ, et al. Operative laparoscopy versus laparotomy for the man-agement of ectopic pregnancy: a prospective trial. Fertil Steril. 1992;57:1180–1185.
    1. Olsson JH, Ellstrom M, Hahlin M, et al. A randomised prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103:345–350.
    1. Sakata S, Watson MO, Grove PM, et al. The conflicting evidence of three-dimensional displays in laparoscopy: a review of systems old and new. Ann Surg. 2016;263:234–239.
    1. Schwab K, Smith R, Brown V, et al. Evolution of stereoscopic imaging in surgery and recent ad-vances. World J Gastrointest Endosc. 2017;9:368–377.
    1. Sinha R, Chawla L, Raje S, et al. Retrospective comparative analysis of 2d versus 3d laparosco-py in total laparoscopic hysterectomy for large uteri (≥ 500g). Surg Technol Int. 2018;33:38–43.
    1. Spille J, Wenners A, von Hehn U, et al. 2D versus 3D in laparoscopic surgery by beginners and experts: a randomized controlled trial on a pelvitrainer in objectively graded surgical steps. J Surg Educ. 2017;74:867–877.
    1. Uccella S, Nero C, Vizza E, et al. Sentinel-node biopsy in early-stage ovarian cancer: prelimi-nary results of a prospective multicentre study (SELLY). Am J Obstet Gynecol. 2019;221:324.
    1. Usta TA, Karacan T, Naki MM, et al. Comparison of 3-dimensional versus 2-dimensional lapa-roscopic vision system in total laparoscopic hysterectomy: a retrospective study. Arch Gynecol Obstet. 2014;290:705–709.
    1. Vizzielli G, Perrone E, Pizzacalla S, et al. Laparoscopic pelvic exenteration with radical vaginec-tomy using 3-dimensional vision and multifunction instrument. Int J Gynecol Cancer. 2018 Nov;28:1805–1806.
    1. Wahba R, Datta R, Bußhoff J, et al. 3D Versus 4K display system - influence of “state-of-the-art”- display technique on surgical performance (idosp-study) in minimally invasive surgery: a randomized cross-over trial. Ann Surg. 2020;272:709–714.
    1. Wenzl R, Pateisky N, Husslein P, et al. Erstmaliger Einsatz eines 3D-Videoendoskopes in der Gynäkologie [First use of a 3D video-endoscope in gynecology]. Geburtshilfe Frauenheilkd. 1993;53:776–778.
    1. Wilson E, Janssens S, McLindon LA, et al. Improved laparoscopic skills in gynaecology trainees following a simulation-training program using take-home box trainers. Aust N Z J Obstet Gynaecol. 2019;59:110–116.
    1. Yamashita H, Aoki H, Tanioka K, et al. Ultra-high definition (8K UHD) endoscope: our first clin-ical success. Springerplus. 2016;5:1445.
    1. Yuen PM, Chang AM. Laparoscopic management of adnexal mass during pregnancy. Acta Obstet Gynecol Scand. 1997;76:173–176.
    1. Zwart MJW, Fuente I, Hilst J, et al. Added value of 3D-vision during laparoscopic biotissue pan-creatico- and hepaticojejunostomy (LAELAPS 3D2D): an international randomized cross-over trial. HPB (Oxford) 2019;21:1087–1094.

Source: PubMed

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