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Dunstan M, Smith R, Schwab K, Scala A, Gatenby P, Whyte M, Rockall T, Jourdan I. Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial. Surg Endosc 2020; 34:1729-1735. [PMID: 31321536 PMCID: PMC7093366 DOI: 10.1007/s00464-019-06958-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND 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. 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. METHODS Patients 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. RESULTS One 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. CONCLUSIONS A 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system.
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Affiliation(s)
- Matt Dunstan
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.
| | - Ralph Smith
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Katie Schwab
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Andrea Scala
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Piers Gatenby
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Martin Whyte
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Tim Rockall
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Iain Jourdan
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
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Hussain A, Nijhawan N, DeAngelis D, Oestreicher J. Perceptions and use of computer-assisted surgery (CAS) in the orbit. Orbit 2019; 38:180-183. [PMID: 29993308 DOI: 10.1080/01676830.2018.1490440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
Computer-assisted surgery (CAS) plays a prominent role in certain surgical disciplines. We investigated the current perceptions and use of this technology for orbital surgery. An online survey was emailed to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Society of Oculoplastic Surgery, and British Oculoplastic Surgery Society. Respondents were asked to describe their practice type and seniority, their frequency of orbital surgery, experience, use, and accessibility of CAS, and their opinion on the technology. There were a total of 151 responses across the societies. 105 respondents (69.5%) had been in attending/consultant practice for over 10 years, with over half (54.7%) working in academic/teaching hospitals. The majority (66.7%) had superficial or no experience with CAS. In total, 84.8% of respondents rarely or never use CAS for orbital surgery (n = 128). Posterior orbital surgery (64.2%) and orbital decompression (49.0%) were the two most useful reasons to implement CAS. Longer operating time (58.3%) and cost (54.8%) were the two most selected weaknesses for CAS, whereas improved accuracy in attaining surgical end point(s) (80.8%) and patient safety (63.6%) were the principal advantages. Type of practice was significantly associated with CAS availability/accessibility (p < 0.05). Proportion of orbital surgery performed in practice was significantly associated with both CAS experience and use (p < 0.05). Our study confirms an expected variation in the perception and use of CAS for orbital surgery. Demonstrated patient benefit and integration of refined and cost-effective CAS systems into operating room environments may influence its future role.
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Affiliation(s)
- Ahsen Hussain
- a Department of Ophthalmology and Visual Sciences , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Navdeep Nijhawan
- b Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Ontario , Canada
| | - Dan DeAngelis
- b Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Ontario , Canada
| | - James Oestreicher
- b Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Ontario , Canada
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Bezruchko MV, Malyk SV, Kravchenko SP, Osipov OS, Sytnik DA. [Dependence of the operation stress degree from the kind of operative intervention for an acute cholecystitis in the patients with high operative-anesthesiological risk]. Klin Khir 2013:22-25. [PMID: 23718028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The results of comparison between the operation stress degree in various kinds of surgical interventions, performed for an acute cholecystitis, using determination of cortizol, prolactin and glucose content before the operation, intraoperatively and postoperatively in 50 patients, are adduced. There was established, that the largest (in 5.3 times) and the most durable (more than 24 hours) intr erative raising of the cortizol level in the blood serum was noted in patients, to whom open cholecystectomy (OCH) was done, and the minimal (in 2.2 times) and the least durable (up to 1 hour)--while performing transcutaneous transhepatic draining (TTD) of gallbladder under ultrasonographic control. While performance of laparoscopic cholecystectomy (LCH) there was noted the most pronounced intraoperative raising of prolactin level (in 3.6 times) and more rapid its lowering (during 24 hours) in comparison with such while the OCH performance (during 72 hours). In TTD there was observed the minimal intraoperative inhancing of the prolactin level (in 2.3 times) and its duration (during 1 hour) postoperatively. The above mentioned have witnessed, that while TTD of gallbladder performance stimulation of the anterior hypophysis is significantly lesser, than while LCH and OCH.
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