However, these systems are expensive, and around ten percent of surgeons cannot perceive stereoscopic depth. Recently, the European Association for Endoscopic Surgery (EAES) has published recommendations that 3D systems should be utilised in the clinical setting to decrease operating times. A systematic review of simulator-based studies has suggested that surgeons complete tasks more quickly and with fewer errors when using dual-channel, passive polarising stereoscopic systems, compared to that when using 2D HD systems. It has been suggested that the introduction of 2D HD and 3D systems have improved depth perception, by enhancing monocular and binocular depth-perception cues, respectively. Advances in video technology, namely high-definition two-dimensional imaging (2D HD) and stereoscopic (three-dimensional) laparoscopes (3D HD), have been developed in an attempt to reduce complication rates and to shorten the learning curve. Inaccurate object localisation and depth perception in laparoscopic surgery may be dangerous. In particular, overcoming the loss of stereoscopic depth perception is associated with a long learning curve.
However, laparoscopic surgery is technically challenging, due to the reduced tactile sensation and degrees of freedom of the instruments, the altered ergonomics, lack of camera stability and loss of binocular depth perception.
The benefits of laparoscopic over open surgery include quicker recovery, and reduced pain, blood loss and wound infection.
ConclusionsĪ 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system. Gallbladder grade also had a significant effect on the error score. Gallbladder grade and operating surgeon had significant effects on time to complete the operation. Stone spillage occurred more frequently with 3D HD, but there were no other differences in individual error rates. No reduction in operative time was detected with 3D HD compared to 4K laparoscopy (median 23.41 min vs 20.90 min p = 0.91) nor was there any decrease observed in error scores (60 vs 58 p = 0.27), complications or reattendance. One hundred and twenty patients were randomised, of which 109 were analysed (3D HD n = 54 4K n = 55).
Blinded video assessment was performed to calculate intraoperative error scores. Operative videos were recorded, and the time from gallbladder exposure to separation from the liver (minus on table cholangiogram) was calculated. Patients undergoing laparoscopic cholecystectomy were randomised to 3D HD or 4K laparoscopy. However their performance against new, ultra-high-definition (‘4K’) systems is not known. Three-dimensional high-definition (3D HD) systems are thought to improve operating times compared to two-dimensional high-definition systems. Developments in high-definition and stereoscopic imaging have attempted to overcome this. Laparoscopic 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.
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