Two-dimensional (2D) versus three-dimensional (3D) laparoscopy for vaginal cuff closure by surgeons-in-training: a randomized controlled trial

• Published in: Surgical endoscopy Vol. 34; no. 3; pp. 1237 - 1243
• Main Authors: Ajao, Mobolaji O., Larsen, Christian R., Manoucheri, Elmira, Goggins, Emily R., Rask, Maja T., Cox, Mary K. B., Mushinski, Avery, Gu, Xiangmei, Cohen, Sarah L., Rudnicki, Martin, Einarsson, Jon I.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Education, Medical, Graduate; Female; Gastroenterology; Gynecology; Hepatology; Humans; Hysterectomy - education; Hysterectomy - methods; Imaging, Three-Dimensional; Internship and Residency; Laparoscopy; Laparoscopy - education; Laparoscopy - methods; Linear Models; Medicine; Medicine & Public Health; Middle Aged; NCT; NCT02192606; Operative Time; Proctology; Surgeons; Surgeons - education; Surgery; Suture Techniques; Vagina - surgery; Vision systems; Vaginal cuff; Laparoscopy; Hysterectomy; Two dimensional; Three dimensional
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-019-06886-9

Background
Objective evidence is lacking as to the benefit of the addition of 3D vision to conventional laparoscopy in Gynecologic surgery. This study aims to compare 3-D visual system to traditional 2-D laparoscopic visualization for the laparoscopic closure of the vaginal cuff during total laparoscopic hysterectomy by surgeons-in-training [defined as senior OBGYN resident or Minimally Invasive Gynecologic Surgery (MIGS) fellow].
Methods
51 patients undergoing total laparoscopic hysterectomy at two tertiary care academic hospitals were randomized to two-dimensional or three-dimensional vision system with cuff closure performed by surgeons-in-training. The primary outcome was the time taken for vaginal cuff closure. Secondary outcomes included peri-operative outcomes and assessment of surgeon’s perception of ease of cuff closure.
Results
27 (52.9%) cases were allocated to cuff closure with the 2D system and 24 (47.1%) cases to closure with the 3D vision system. Patient baseline characteristics were similar between the vision systems. Mean vaginal cuff closure time was not significantly different between 2D and 3D vision (10.1 min for 2D versus 12 min for 3D,
p
 = 0.31). An additional 24 s was added to cuff closure time with each 1 kg/m
2
increase in BMI, after controlling for potential confounders (
p
 = 0.003). There was no difference in the surgeon rating of ease of cuff closure between 2D and 3D. Peri-operative outcomes are similar among the two groups.
Conclusion
We did not demonstrate any benefits of 3D vision system over conventional 2D for the task of laparoscopic vaginal cuff suturing performed by surgeons-in-training.
RCT Registration Number
NCT02192606
https://clinicaltrials.gov/ct2/show/NCT02192606
(July 17, 2014)