Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
J Pediatr Surg. 2022 Feb;57(2):235-238. doi: 10.1016/j.jpedsurg.2021.10.046. Epub 2021 Nov 11.
The safety and success of laparoscopic choledochal cyst surgery (LapCC) depends upon two critical elements during the hepaticojejunostomy anastomosis (HJA). These may be termed the Difficulty of Differentiation (DOD) and the Difficulty of Suturing (DOS). The type of imaging system (2 or 4 K) used may influence either of these. We compared outcomes of LapCC using 2 or 4 K imaging systems.
LapCC were performed at a single institution by the same team using a 2 K system (2009-2018; n = 26) and a 4 K system (2018-2019; n = 11) were compared. 4 K cases were chosen to match 2 K cases to minimize bias. Five independent senior pediatric surgeons scored DOD and DOS blindly from intraoperative video recordings of LapCC using a subjective 5-point scale (5: impossible, 4: difficult, 3: tedious, 2: slow, and 1: easy) and rated their over all impression as +1 if 4 K was better, 0 if they were the same, and -1 if 4 K was worse. Total HJA anastomosis time (TAT) and TAT/suture were also calculated.
LapCC was performed in 37 age/weight/HJA diameter matched children. Scores for DOD (p<0.001) were lower with 4 K with less variance, although there was no difference in DOS (p = 0.08). Operative time (p = 0.03) and duration of hospitalization (p < 0.001) were significantly shorter with 4 K. 4 K was rated +1 unanimously. There was no difference in TAT (p = 0.17) and TAT/suture (p = 0.22). There was one HJA leak with 2 K (3.8%) and no complications with 4 K.
Improved resolution with 4 K improved the progress of surgery as reflected by shorter operative time and duration of hospitalization, enhancing the performance of LapCC in children.
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腹腔镜胆总管囊肿手术（LapCC）的安全性和成功取决于肝肠吻合术（HJA）过程中的两个关键因素。这些因素可以被称为分化难度（DOD）和缝合难度（DOS）。所使用的成像系统（2K 或 4K）的类型可能会影响这两个因素。我们比较了使用 2K 和 4K 成像系统进行 LapCC 的结果。
同一团队在一家机构中进行了 LapCC，使用 2K 系统（2009-2018 年；n=26）和 4K 系统（2018-2019 年；n=11）进行比较。选择 4K 病例以匹配 2K 病例，以尽量减少偏倚。五名独立的资深儿科外科医生使用主观的 5 分制（5：不可能，4：困难，3：繁琐，2：缓慢，1：容易）从 LapCC 的术中视频记录中对 DOD 和 DOS 进行盲评，并根据他们的整体印象进行评分+1（如果 4K 更好）、0（如果相同）和-1（如果 4K 更差）。还计算了总 HJA 吻合时间（TAT）和 TAT/缝合线。
在 37 名年龄/体重/HJA 直径匹配的儿童中进行了 LapCC。尽管 DOS 没有差异（p=0.08），但 4K 时 DOD 评分（p<0.001）更低，差异更小。手术时间（p=0.03）和住院时间（p<0.001）显著缩短。4K 被一致评为+1。TAT 无差异（p=0.17）和 TAT/缝合线（p=0.22）无差异。2K 时有 1 例 HJA 漏（3.8%），4K 无并发症。
4K 的分辨率提高改善了手术进展，表现为手术时间和住院时间缩短，增强了儿童 LapCC 的性能。
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