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Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial

Dunstan, Matt, Smith, Ralph, Schwab, Katie, Scala, Andrea, Gatenby, Piers, Whyte, Martin, Rockall, Tim and Jourdan, Iain (2019) Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial Surgical Endoscopy. pp. 1-7.

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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.


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.


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.


A 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Smith, Ralph
Schwab, Katie
Scala, Andrea
Gatenby, Piers
Rockall, Tim
Jourdan, Iain
Date : 18 July 2019
DOI : 10.1007/s00464-019-06958-w
Copyright Disclaimer : © The Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Uncontrolled Keywords : Laparoscopy; Cholecystectomy; Depth Perception; Imaging; Three-Dimensional
Depositing User : Clive Harris
Date Deposited : 09 Sep 2019 13:22
Last Modified : 09 Sep 2019 13:22

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