International Centre for Surgical Safety, St Michael's Hospital, Toronto, Ontario, Canada.
Keenan Centre for Biomedical Research, St Michael's Hospital, Toronto, Ontario, Canada.
JAMA Netw Open. 2020 Jan 3;3(1):e1920084. doi: 10.1001/jamanetworkopen.2019.20084.
Errors and adverse events occur frequently in health care. Three-dimensional (3-D) laparoscopic systems claim to provide more realistic depth perception and better spatial orientation compared with their 2-D counterparts.
To compare the association of 3-D vs 2-D systems with technical performance during laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures using a multiport intraoperative data capture system.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was performed between May and December 2018, with a total of 50 LRYGB procedures performed in an academic tertiary care center; recordings of the operations were evaluated with a 30-day follow-up. All procedures were performed by the same surgical team.
Surgical teams used 2-D or 3-D laparoscopic systems.
Technical performance was evaluated using the Objective Structured Assessment of Technical Skill and surgical errors and events using the Generic Error Rating Tool.
Of the 50 patients who underwent LRYGB procedures, 42 (86%) were women, with a median (interquartile range) age of 42 (35-47) years and a median (interquartile range) body mass index of 46 (42-48), with no significant demographic differences between the groups whose operations were performed using the 2-D and 3-D systems. The mean (SD) number of errors per case was significantly lower in procedures using the 3-D laparoscopic system than in those using the 2-D system (17 [6] vs 33 [2]; P < .001). The mean (SD) number of error-related events was significantly lower in procedures using the 3-D system than in those using the 2-D system (6 [2] vs 11 [4]; P < .001). Mean (SD) Objective Structured Assessment of Technical Skill scores were significantly higher when the 3-D system was used than when the 2-D system was used (28 [4] vs 22 [3]; P < .001).
In this limited sample of LRYGB procedures, the use of a 3-D laparoscopic system was associated with a statistically significant reduction in errors and events as well as higher Objective Structured Assessment of Technical Skill scores compared with 2-D systems.
医疗保健中经常会出现错误和不良事件。与二维（2-D）系统相比，三维（3-D）腹腔镜系统声称提供更逼真的深度感知和更好的空间定位。
使用多端口术中数据采集系统比较 3-D 与 2-D 系统与腹腔镜 Roux-en-Y 胃旁路术（LRYGB）手术中的技术性能的关联。
设计、地点和参与者：这项队列研究于 2018 年 5 月至 12 月进行，在一家学术性三级护理中心共进行了 50 例 LRYGB 手术；通过 30 天随访评估手术记录。所有手术均由同一手术团队完成。
手术团队使用 2-D 或 3-D 腹腔镜系统。
使用客观结构化手术技能评估和通用错误评分工具评估技术性能。
在接受 LRYGB 手术的 50 名患者中，有 42 名（86%）为女性，中位（四分位间距）年龄为 42（35-47）岁，中位（四分位间距）体重指数为 46（42-48），使用 2-D 和 3-D 系统进行手术的两组患者在人口统计学方面无显著差异。使用 3-D 腹腔镜系统的手术中每例患者的平均（SD）错误数明显低于使用 2-D 系统的手术（17 [6] vs 33 [2]；P <.001）。使用 3-D 系统的手术中与错误相关的事件平均（SD）数明显低于使用 2-D 系统的手术（6 [2] vs 11 [4]；P <.001）。使用 3-D 系统时，客观结构化手术技能评估的平均（SD）得分明显高于使用 2-D 系统时（28 [4] vs 22 [3]；P <.001）。
在这项有限的 LRYGB 手术样本中，与 2-D 系统相比，使用 3-D 腹腔镜系统与错误和事件数量统计学显著减少以及客观结构化手术技能评估得分更高相关。
