Comparison of 3D imaging and 2D imaging for performance time of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) has become the most widely used treatment for gallbladder (GB) disease. In many countries, the preferred procedure of cholecystectomy is LC.1 Majority of studies comparing 3-dimensional (3D) imaging systems with 2D imaging systems for LC showed a decrease in performance time.2–6 Those studies in which no significant was found between the 2 systems had used more primitive versions of 3D instruments.7–10 Only some of the comparative studies have been conducted with the new 3D imaging system (Viking, da Vinci Robotic system), which all concluded that the 3D system is superior.2,5,6 Previous studies analyzed the effects of the Viking 3D system and da Vinci system on the performance of the surgeon and its utility as an educational tool for laparoscopic surgery.2,5,6,10 In this study, we aimed to evaluate the clinical utility of the Viking 3D system. MATERIALS AND METHODS The patient group included 72 patients selected from a group of 120 patients who underwent elective surgery for GB diseases between August 2010 and April 2011. This study had been conducted with the approval of Yildirim Beyazit Education and Research Hospital’s Ethical Committee. All of the patients had signed an informed consent. Obesity and a history of acute cholecystitis or any abdominal surgery were the initial exclusion criteria of the study. The patients were evaluated with preoperative ultrasonography (US) and perioperative exploration findings (Fig. 1). We established a multiparameter filter (MPF) to standardize the groups. The patients excluded from the study if they had at least one of these parameters that are thought to have an implication on performance time and labeled as MPF positive and otherwise MPF negative. These parameters were wall thickness of GB in US and GB ejection fraction (EF) in US preoperatively and dens omental adhesion to GB, adhesion of other abdominal organs to GB, difficulties of the Callot triangle dissection, existence of an anatomic variation, impacted stone to GB neck, and adhesion of GB neck to main biliary tracts perioperatively. The US evaluations of all patients were performed by the same radiologist on the day before the surgery, after a 6-hour fasting. Postprandial GB volume was determined 30 minutes after consumption of a fat-rich diet (80 g chocolate). GB maximum EF was determined by comparing the difference between the fasting and postprandial volume to fasting volume. EFZ60% was accepted as normal and EF<60% was regarded as insufficient. Perioperative evaluation of the patients according to MPF and the measurement of the performance time of LC were carried out by the same observer surgeon who is experienced in minimally invasive surgery. In this study, our surgery team included 4 surgeons—3 performers and 1 observer. Each surgeon performed 5 LC with 3D system during the study period. All 4 surgeons have extensive experience with the 2D system, but none of them had used a 3D system before. The total performance time was accepted as the period starting with the entrance of the Veress needle into the abdomen and ending with the extraction of the GB from the abdomen and recorded on the patients file by the observer surgeon. The Viking system was provided to us for a period of 1 week for demonstration purposes. Fifteen patients who were ready for the surgery at this 1-week period were operated with the Viking 3D system. Four patients recorded as MPF positive were excluded. The remaining 11 patients, all of whom were female with a median age of 53, had been put into group A. Fifty-seven patients were Received for publication December 26, 2011; accepted October 11, 2012. From the *Department of General Surgery, Medical Faculty, Ordu University, Ordu; wDepartment of General Surgery, Jinemed Hospital, Istanbul; zFirst Department of General Surgery, Ankara Yildirim Beyazit Training and Research Hospital, Ankara; and yDepartment of General Surgery, Adana Training Hospital, Adana, Turkey. The authors declare no conflicts of interest. Reprints: Koksal Bilgen, MD, Department of Surgery, Medical Faculty, Ordu University, Nefsibucak Caddesi Bucak Mahallesi, Ordu, Turkey 52200 (e-mail: koksalbilgen@gmail.com). Copyright r 2013 by Lippincott Williams & Wilkins ORIGINAL ARTICLE