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

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.

The Era of 4K Three-dimensional Imaging is Coming

“…Moreover, its advantages in terms of reduction in intraoperative blood loss, infections, and pain as well as shorter hospitalization and better cosmesis are now well recognized. [ 1 ] Currently, the laparoscopic technique is increasingly being utilized in performing simple and complex gynecologic procedures for various benign and malignant gynecologic conditions. [ 2 3 4 5 6 7 8 ]…”

“…[ 9 ] As early laparoscopic techniques relied on conventional two-dimensional (2D) imaging with limited depth perception, surgeons have to acquire different psychomotor skills as well as visuospatial competencies to work in a 3D abdominal space reflected in 2D images. [ 1 9 10 11 ] Attempts to address these concerns and to overcome the major drawback in the traditional 2D imaging system led to the development of 3D laparoscopy. [ 1 10 ]…”

“…[ 1 9 10 11 ] Attempts to address these concerns and to overcome the major drawback in the traditional 2D imaging system led to the development of 3D laparoscopy. [ 1 10 ]…”

“…The adoption of 3D imaging in laparoscopy introduced a new dimension, providing surgeons with enhanced depth perception, facilitating more precise maneuvers, and better anatomical understanding during gynecologic surgeries. [ 1 9 11 12 13 ] Since its introduction in the 90’s, improvements have been made effectively minimizing the adverse effects experienced by the laparoscopist such as nausea, vomiting, dizziness, and visual fatigue associated with the early generation of 3D technology. [ 1 12 ] Gradually, the 3D high-definition (HD) endovision system has gained acceptance among laparoscopic surgeons worldwide.…”

“…[ 1 9 11 12 13 ] Since its introduction in the 90’s, improvements have been made effectively minimizing the adverse effects experienced by the laparoscopist such as nausea, vomiting, dizziness, and visual fatigue associated with the early generation of 3D technology. [ 1 12 ] Gradually, the 3D high-definition (HD) endovision system has gained acceptance among laparoscopic surgeons worldwide. [ 12 ] Moreover, the European Association of Endoscopic Surgery reached a consensus recommending the use of 3D technology because it was associated with not only a shortened operative time but also a significant reduction in complication rate, especially in surgeries that involved laparoscopic suturing.…”