In recent years, endoscopically placed endoprosthesis has become an alternative to traditional operative biliary-digestive bypass in palliative treatment of patients with non-resectable biliary obstruction caused by malignant stricture of the extrahepatic bile duct. In an uncontrolled series the endoscopic approach has been recommended as the treatment of choice.' Alternatively surgery has been recommended primarily because 13% of the survivors needed a later operation for duodenal obstruction.2 The combined intraoperative and postoperative mortality (30 days mortality) after bypass surgery is reported to be 15-30%,2 and the corresponding mortality for the endoscopic approach 10-18%.'3 The procedure related mortality of endoprosthesis insertion was low (0-2%),' and success rates in the application of the stent were high (90%).' Sonnenfeld et al' reported a non-randomised comparison of endoprosthesis versus bypass with 20 patients in each group and found no difference in survival, but the

Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.

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