4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial

BACKGROUND: The introduction of ultra-high-definition laparoscopic cameras (4K), by providing stronger monocular depth perception, could challenge the existing 3D technology. There are few available studies on this topic, especially in gynaecological setting. OBJECTIVES: To compare operating times using 3D and 4K vision systems for total laparoscopic hysterectomy performed by surgeons in training. MATERIALS AND METHODS: In this prospective, single institution, randomised clinical trial (NCT04209036) two laparoscopes utilised were the 0°ULTRA Telescopes with 4K technology and the 0°3D-HD. The surgeons were all trainees and in their last year of residency and who had obtained the certificate of first or second level of the Gynaecological Endoscopic Surgical Education and Assessment (GESEA) programme. Twenty-nine patients with benign uterine pathology were enrolled. MAIN OUTCOME MEASURES: Operative time for total laparoscopic hysterectomy. RESULTS: The 3D vision system did not prove to be superior to the 4K vision system. Operators reported significantly more vision-related side effects when using 3D than 4K. Completing the GESEA training programme was the only factor with a positive and statistically significant impact on the overall time of the procedure, especially when greater dexterity and tissue handling were required. CONCLUSIONS: Neither technology used proved superior to the other, although operators showed a preference for 4K over 3D due to the lower number of visual side effects. Attendance at courses on laparoscopic simulators and training programmes allowed trainees to demonstrate excellent surgical skills.