Journal of the European Society for Gynaecological Endoscopy


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

S. Restaino 1, V. Vargiu 2, A. Rosati 2, M. Bruno 2, G. Dinoi 2, E. Cola 2, R. Moroni 3, G. Scambia 2,4, F. Fanfani 2,4

1 Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100, Udine, Italy
2 Division of gynecological oncology, Department of Obstetric and Gynecology, Catholic University of Sacred Heart, L.go A. Gemelli; 00167 Roma (RM), Italy
3 Scientific Direction, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, Rome, Lazio, Italy; 4 Università Cattolica del Sacro Cuore, Roma, Italy


laparoscopy, trainee; 4K laparoscopy, 3D laparoscopy

Published online: Sep 24 2021


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: Prospective, single institution, randomised clinical trial (NCT04209036).

Materials and Methods: The two laparoscopes utilised were the 0°ULTRA Telescopes with 4K technology and the 0°3D-HD by Olympus. 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 program - GESEA program. Twenty-nine patients with benign uterine pathology were enrolled.

Main outcome measures: To compare if the use three-dimensional (3D) versus ultra-high-definition laparoscopic vision system (4K) for total laparoscopic hysterectomy performed by trainees was associated with a  shorter operative time.

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 program 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 programs allowed trainees to demonstrate excellent surgical skills.