REDUCED CONVERSION RATE IN LAPAROSCOPIC CHOLECYSTECTOMY AND APPENDECTOMY BY INAUGURATION OF THREE-DIMENSIONAL (3D) LAPAROSCOPY
Said Malke3, Birgit Herzinger2, Daniel Sandor2, Markus Worm2, Frank Meyer*1, Ralf Steinert2
1Dept. of General, Abdominal, Vascular and Transplant Surgery; Otto-von-Guericke University with University Hospital, Magdeburg, Germany; 2Dept. of General and Abdominal Surgery, Municipal Hospital ("St. Josefs-Krankenhaus"), Salzkotten, Germany; 3Dept. of General and Abdominal Surgery, Municipal Hospital ("St. Vincenz-Krankenhaus"), Paderborn, Germany
Introduction: 4K-image quality or three-dimensional (3D) imaging have improved substantially the options for laparoscopy in addition to telemanipulators & robotics. The usually observed conversion rate for cholecystectomy amounts approximately 5-8 % as found in clinical studies. The last Germany-wide study on acute appendicitis showed a laparoscopic appendectomy rate of 84 %.
Therefore, the question was raised, can 3D technique achieve to lower further conversion rate of representative minimally invasive surgical interventions such as cholecystectomy & appendectomy.
Material and Methods: 3D laparoscopy was inaugurated in the reporting institution in October 2018 (EinsteinVision® 3D Kamerasystem; B. Braun Deutschland GmbH & Co. KG, Tuttlingen/Germany). In this analysis, all consecutive patients who had undergone cholecystectomy & appendectomy (elective & emergency surgical interventions) were included in this systematic clinical prospective single-center observational study highlighting real-world data obtained in daily surgical practice & considered as a contribution to quality assurance & research on clinical care over a defined study period. No surgeon was excluded. Uncomplicated cholecyst- & appendectomies were considered surgical interventions for residents‘ training. Main focus of the here exposed study aspect was conversion rate compared with data of a historical group, which had been obtained using 2D-HD laparoscopy over the 8 years before starting to use 3D laparoscopy.
Results: From 2011 to August 2019, overall 1,517 cholecystectomies (out of them, 94.7 % with a laparoscopic approach) & 687 appendectomies (out of them, 93.4 % with a laparoscopic approach) were performed, enrolled in the study & documented. Since October 2018, all minimally invasive surgical interventions have been performed using 3D technique (cholecystectomies, n=147; appendectomies, n=93). Rates of conversion from a laparoscopic onto an open approach from 2011 to 10/2018 were as follows: cholecystectomy, 3.4 % (n=42) & appendectomy, 3.8 % (n=19). Primary conventional (open) surgical intervention rates were 2.9 % (n=35) in cholecystectomy & 5.2 % (n=26) in appendectomy, respectively. Using 3D technique, all appendectomies were accomplished whereas in 3D cholecystectomy, conversion rate was 0.7 % (n=1) the same as found for primary open surgery.
Conclusion: Institutional inauguration of 3D laparoscopy was associated with a reduced conversion rate from 3.1 % down to 0.7 % in cholecystectomy. Furthermore, there was a reduced rate of a primary open-surgery approach from 2.6 % down to 0.7 %. All laparoscopic appendectomies were accomplished with no required conversion using 3D laparoscopy. In addition, there was a high rate of acceptance for the novel technology. However, as part of the training in surgical residency, proper handling of 2D technique is still indispensable.
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