Comparison of 30-degree and 0-degree laparoscopes in the visualisation of the inferior epigastric vessel, rectus abdominis muscle and bladder dome in gynaecologic laparoscopy

Clear visualisation of the inferior epigastric vessel and bladder dome is important to avoid ancillary port injury. In this prospective cohort study, 52 videos of gynaecologic laparoscopies performed at Songklanagarind Hospital were scored by three expert and three non-expert surgeons in terms of visualisation quality and confidence level in identifying the inferior epigastric vessel, rectus abdominis muscle and bladder dome using 0-degree and 30-degree laparoscopes. No significant difference was reported between the laparoscopes regarding both visualisation quality and confidence level in identifying these three landmarks. When using the 30-degree laparoscope, expert surgeons reported significantly higher visual rating scale scores for both visualisation quality and confidence level than did non-expert surgeons (7.6 (5.3-8.6) vs. 6.5 (4.4-8.3); p=.04 and 7.3 (5.7-8.6) vs. 6.2 (5.2-7.5); p=.02). In conclusion, the two laparoscope angles were similar in terms of both visualisation quality and confidence level in visualising the inferior epigastric vessel and bladder dome.Impact Statement What is already known on this subject? Most laparoscopic complications associated with vascular and bladder injuries occur during the process of abdominal penetration. The 30-degree laparoscope tends to be superior to the 0-degree laparoscope in terms of visualisation in the lateral axis. A previous study reported the benefits of using the 30-degree laparoscope in urologic surgery. Data related to the degree of the laparoscope suitable for avoiding abdominal wall injuries are lacking. What do the results of this study add? We demonstrated that both 0- and 30-degree laparoscopes were similar in terms of visualisation and confidence level for the identification of the inferior epigastric vessel and bladder dome. Using the 30-degree laparoscope, expert surgeons reported higher scores for the visualisation of the inferior epigastric vessel than did non-expert surgeons. What are the implications of these findings for clinical practice and/or further research? Before ancillary port penetration, we recommend using either a 30-degree or 0-degree laparoscope to visualise the inferior epigastric vessel and bladder dome. For non-expert surgeons, a learning curve is required to improve the visualisation quality and confidence level for identifying these landmarks, especially using the 30-degree laparoscope.