2D vs 3D laparoscopic right colectomy: A propensity score-matching comparison of personal experience with systematic review and meta-analysis

Abstract

BACKGROUND The benefits of laparoscopic approach for right colectomy have been well established. However, the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome. AIM To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis. METHODS A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed. A systematic review was accomplished comparing 2D and 3D right colectomy. RESULTS In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group. The 3D group showed a favorable trend in terms of mean operative time (170.7 ± 32.9 min vs 183.8 ± 35.4 min; P = 0.053) and a significant lower anastomotic time (16.9 ± 2.3 min vs 19.6 ± 2.9 min, P < 0.001). The complete mesocolic excision (CME) subgroups analysis showed a shorter anastomotic time (16.5 ± 1.8 min vs 19.9 ± 3.0 min; P < 0.001) and operative time (175.0 ± 38.5 min vs 193.7 ± 37.1 min; P = 0.063) in the 3D group. Six studies and our series were included in the meta-analysis with 551 patients (2D group: 291; 3D group: 260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time ( P < 0.001) and the anastomotic time ( P < 0.001) while no differences were identified between groups in terms of blood loss ( P = 0.827), LNH yield ( P = 0.243), time to first flatus ( P = 0.333), postoperative complications ( P = 0.718) and length of stay ( P = 0.835). CONCLUSION The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy. In our series, the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.

Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

“…Operative time in righthemicolectomies with ICA has been shown to be completed faster with 3D laparoscopy compared with robotic, with similar patient outcomes, suggesting that additional benefits arise due to improved visualization of tissue planes through 3D rather than increased articulation, which has also been demonstrated in other surgical procedures. [19][20][21] Subsequently, studies published after these meta-analysis show similar results. The MERCY study (2022) was able to demonstrate decreased surgical site infections, time to regular diet, and estimated intraoperative blood loss while maintaining similar mortality and readmission rates.…”

Laparoscopic surgery in 3D improves results and surgeon convenience in sleeve gastrectomy for morbid obesity

“…Regarding the average duration of the surgical intervention, many studies coincide in a reduction of the procedure time using 3D technology when compared to 2D laparoscopy in various types of surgery [14][15][16][17]. In the study by Costa et al in 2021 in colonic surgery [16], the most frequent surgery performed in the world showed a significantly lower anastomotic time (16.9 ± 2.3 min vs. 19.6 ± 2.9 min) in the 3D group compared to the 2D group.…”

“…Regarding the average duration of the surgical intervention, many studies coincide in a reduction of the procedure time using 3D technology when compared to 2D laparoscopy in various types of surgery [14][15][16][17]. In the study by Costa et al in 2021 in colonic surgery [16], the most frequent surgery performed in the world showed a significantly lower anastomotic time (16.9 ± 2.3 min vs. 19.6 ± 2.9 min) in the 3D group compared to the 2D group. More specifically in bariatric surgery, in the study by Padín et al in 2017 [17], surgical times were also analyzed being 100.22 ± 41.22 min in the 3D group and 124.7 ± 51.97 min in the 2D group, with a statistically significant difference.…”

“…However, as vision systems have improved, most of the more recent studies comparing these two technologies conclude in favor of the 3D technique for all of the above. In general surgery, studies on laparoscopic cholecystectomy [26,27], laparoscopic surgery for colon cancer [16,28,29], and laparoscopic duodenopancreatectomy [30], as well as previous studies on gastric cancer [31][32][33] and laparoscopic liver resection [34], reported improvements in surgical time and complications with 3D laparoscopy.…”

Intraoperative and Postoperative Complications of Three Dimensional (3D) Laparoscopic Cholecystectomy

“…Laparoscopic procedures have revolutionized the field of surgery by providing minimally invasive techniques for various surgeries 1 . Two-dimensional (2D) laparoscopic procedures have been in use for a long time, but with advancements in technology, threedimensional (3D) laparoscopy has emerged as a viable alternative 2 . The use of a 3D camera system in laparoscopic procedures provides surgeons with a more realistic and detailed view of the surgical site, enabling them to perform complex surgeries with greater precision and accuracy 3 .…”