COMPARISON OF 2K AND 4K IMAGING SYSTEMS FOR LAPAROSCOPIC REPAIR OF CHOLEDOCHAL CYST IN CHILDREN

ABSTRACT Aim 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 (2K or 4K) used may influence either of these. We compared outcomes of LapCC using 2k or 4K imaging systems. Methods LapCC were performed at a single institution by the same team using a 2K system (2009-2018; n=26) and a 4K system (2018-2019; n=11) were compared. 4K cases were chosen to match 2K 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 overall impression as +1 if 4K was better, 0 if they were the same, and -1 if 4K was worse. Total HJA anastomosis time (TAT) and TAT/suture were also calculated. Results LapCC was performed in 37 age/weight/HJA diameter matched children. Scores for DOD (p There was one HJA leak with 2K (3.8%) and no complications with 4K. Conclusions Improved resolution with 4K improved the progress of surgery as reflected by shorter operative time and duration of hospitalization, enhancing the performance of LapCC in children.